Infection and Drug Resistance (Jun 2023)
The CREPE Score: A Predictive Tool for Third-Generation Cephalosporin-Resistant Enterobacterales Pneumonia in Community Settings
Abstract
Krisada Khunkitti,1,* Wantin Sribenjalux,2,3,* Waewta Kuwatjanakul,4 Itthiphat Arunsurat,5 Apichart So-ngern,6 Atibordee Meesing2,3 1Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand; 4Microbiology Unit, Clinical Laboratory Section, Srinagarind Hospital Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 6Division of Sleep Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand*These authors contributed equally to this workCorrespondence: Wantin Sribenjalux, Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, 123 Moo 16 Mittraphap Road, Nai-Muang, Muang District, Khon Kaen, 40002, Thailand, Tel +66 4300 9700, Email [email protected]; [email protected]: To evaluate risk factors and develop a prediction score for community-acquired pneumonia caused by third-generation cephalosporin-resistant Enterobacterales (3GCR EB-CAP).Patients and Methods: A retrospective study was conducted by reviewing the medical records of patients hospitalized with community-acquired pneumonia caused by Enterobacterales (EB-CAP) between January 2015 and August 2021 at Srinagarind Hospital, Khon Kaen University, Thailand. Logistic regression was used to analyze clinical parameters associated with 3GCR EB-CAP. The coefficients of significant parameters were simplified to the nearest whole number for a prediction score, called the CREPE (third-generation Cephalosporin Resistant Enterobacterales community-acquired Pneumonia Evaluation).Results: A total of 245 patients with microbiologically confirmed EB-CAP (100 in the 3GCR EB group) were analyzed. Independent risk factors for 3GCR EB-CAP included in the CREPE score were (1) recent hospitalization within the past month (1 point), (2) multidrug-resistant EB colonization (1 point), and (3) recent intravenous antibiotic use (2 points for within the past month or 1.5 points for between one and twelve months). The CREPE score had an area under the receiver operating characteristic curve (ROC) of 0.88 (95% CI 0.84– 0.93). Using a cut-off point of 1.75, the score had a sensitivity and specificity of 73.5% and 84.6%, respectively.Conclusion: In areas with high prevalence of EB-CAP, the CREPE score can assist clinicians in selecting appropriate empirical therapy and reducing overuse of broad-spectrum antibiotics.Keywords: community acquired pneumonia, Enterobacterales, third-generation cephalosporin-resistance, empirical antibiotics, CREPE score
