The GSDCS (0-4.3) score clearly differentiated the low (0-1.3), medium (1.4-2.3) and high (2.4-4.3) risk patients, both for RGNB infection (p:0.003) and bacteremia (p:0.009). It was validated prospectively in a subsequent cohort (n = 408) and the area-under-the-curve (AUC) of the GSDCS score for predicting nosocomial ICU acquired RGNB infection and bacteremia was 0.77 (95% CI 0.68-0.89 and 0.78 (95% CI 0.69-0.89) respectively. The following independent risk factors were obtained by a multivariable logistic regression analysis - prior isolation of Gram negative organism (coeff: 1.1, 95% CI 0.5-1.7) Surgery during current admission (coeff: 0.69, 95% CI 0.2-1.2) prior Dialysis with end stage renal disease (coeff: 0.7, 95% CI 0.1-1.1) prior use of Carbapenems (coeff: 1.3, 95% CI 0.3-2.3) and Stay in the ICU for more than 5 days (coeff: 2.4, 95% CI 1.6-3.2).
Seventy-six patients with nosocomial RGNB Infection (31bacteremia) were compared with 1398 patients with Systemic Inflammatory Response Syndrome (SIRS) without any gram negative bacterial infection/colonization admitted to the ICUs during the study period. This was prospectively validated with a subsequent cohort of patients admitted to the ICUs during the following time period of January-September 2012. A prediction score was formulated by using independent risk factors obtained from logistic regression analysis. All patients who developed nosocomial RGNB infections 48 hours after ICU admission were identified. All adult patients who were admitted and stayed for more than 24 hours at the medical and surgical ICU's were included. We conducted a prospective observational study from August'07 to December'11. The aim of this study was to develop a tool to predict nosocomial RGNB infections among ICU patients for targeted therapy. The widespread use of empiric broad spectrum antibiotics has contributed to the global increase of Resistant Gram-Negative Bacilli (RGNB) infections in intensive care units (ICU).
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