Frontiers in cellular and infection microbiology
Prediction of vancomycin-resistant phenotype in ICU-onset sterile-site Enterococcus-positive cultures: development and pseudo-temporal validation of a clinical prediction model using MIMIC-IV
By Sun W, Gu XL, Ma Q and 2 others.
Abstract
Background
Vancomycin-resistant enterococci challenge intensive care. During the interval between organism identification and final phenotypic antimicrobial susceptibility testing, clinicians must balance delayed effective anti-VRE therapy against unnecessary anti-VRE exposure. We aimed to develop and pseudo-temporally validate a model for the vancomycin-resistance phenotype of the index isolate; the model does not determine whether the isolate represents clinically significant infection.
Methods
In this retrospective MIMIC-IV cohort, adult ICU admissions with a sterile-site Enterococcus-positive culture obtained more than 48 hours after ICU admission were assigned by de-identified anchor-year group to development (groups labelled 2008-2016; n = 552) or pseudo-temporal validation (2017-2022; n = 259). Predictors were restricted to information available by specimen collection. Elastic Net with bootstrap stability screening retained 19 of 141 candidates; four tree-based models were comparators.