ESBL Risk Calculator

For patients 1) presenting with signs and symptoms of infection and 2) having a historical clinical specimen culture positive for ESBL-producing E. coli or K. pneumoniae, the ESBL Risk Calculator estimates the chance that the current (subsequent) infection is caused by ESBL-producing E. coli or K. pneumoniae. The ESBL Risk Calculator is not intended to estimate the chance that a patient has a first infection caused by ESBL-producing E. coli or K. pneumoniae. Likewise, the ESBL Risk Calculator is not intended to be used for resistant organisms other than ESBL-producing E. coli or K. pneumoniae. The performance of the ESBL Risk Calculator may vary based on local rates of ESBL-producing organisms. It is possible the performance of the ESBL Risk Calculator may change over time with changing rates of ESBL production among E. coli and K. pneumoniae.

The ESBL Risk Calculator was developed using retrospectively collected data from a single health system. Estimates from the ESBL Risk Calculator only take certain information into account. There may be other important factors that are not included in the calculator, which may increase or decrease the risk of a subsequent infection caused by ESBL-producing E. coli or K. pneumoniae. A patient’s infection may be caused by an ESBL-producing E. coli or K. pneumoniae even if the ESBL Risk Calculator results with a low percent estimate.

cciValues = [
  {condition: "Prior myocardial infarction", value: 1},
  {condition: "Heart failure", value: 1},
  {condition: "Peripheral vascular disease", value: 1},
  {condition: "Cerebrovascular disease", value: 1},
  {condition: "Dementia", value: 1},
  {condition: "Chronic pulmonary disease", value: 1},
  {condition: "Rheumatologic disease", value: 1},
  {condition: "Peptic ulcer disease", value: 1},
  {condition: "Diabetes, uncomplicated", value: 1},
  {condition: "Diabetes with chronic complications", value: 2},
  {condition: "Hemiplegia or paraplegia", value: 2},
  {condition: "Moderate to severe renal disease", value: 2},
  {condition: "Leukemia", value: 2},
  {condition: "Lymphoma", value: 2},
  {condition: "Mild liver disease", value: 1},
  {condition: "Moderate or severe liver disease", value: 3},
  {condition: "Solid tumor, localized", value: 2},
  {condition: "Solid tumor, metastatic", value: 6},
  {condition: "Acquired immuno-deficiency syndrome (AIDS)", value: 6},
  
]

locationOfCare = [
  {location: "Outpatient"},
  {location: "Emergency Dept/ Urgent Care"},
  {location: "Nursing Home"},
  {location: "Inpatient, non-ICU"},
  {location: "Inpatient ICU"},

]

sexDsc = [
  {location: "Female"},
  {location: "Male"}
]

suspectedSource = [
  {location: "Urinary"},
  {location: "Abdominal"},
  {location: "Respiratory"},
  {location: "Wound, bone, soft-tissue"},
  {location: "IV cathether"},
  {location: "Other"},
  {location: "Unknown"}
]

suspectedLocation = [
  {location: "US - Midwest"},
  {location: "US - Northeast"},
  {location: "US - South"},
  {location: "US - West (including AK/HI)"},
  {location: "Non-US"}
]

viewof sourceGeography = Inputs.radio(suspectedLocation.map(d => d.location),{
  label: "Geographic Location",
  multiple: false
})

currentTimeUse= new Date()

viewof timeculture ={
const inputs = Inputs.date(
  {required: true, label: "Date of Historical ESBL+ Culture:", max: currentTimeUse});
  inputs.classList.add("hello");
return inputs;
}

viewof careLocationName = Inputs.radio(locationOfCare.map(d => d.location),{
  required: true, label: "Location of Care"
})

viewof sourceLocationName = Inputs.checkbox(suspectedSource.map(d => d.location),{
  label: "Suspected Source",
  multiple: true,
  required: true
})

viewof abx_last_90 = {
  const inputs = Inputs.toggle({ values: [1,0],label: html`Antibiotics Last 90 Days<br>(Not for current infection), yes`});
  inputs.classList.add("hello");
  return inputs;
}

cciScored = cciValues.filter(function(cciValues) {
  return cciSelected.includes(cciValues.condition);
});

viewof ageInput = Inputs.range(
  [1,120], {step:1, label: "Age (years)"}
)

viewof sexInput = Inputs.radio(sexDsc.map(d => d.location),{
  label: "Sex",
  required: true
})

cciTotal = {
  let score = d3.sum(cciScored, d => d.value);
  
  if(score > 16){
    return 16;
  } else if (score < 1) {
    return 1;
  } else {
    return score;
  }

  }

viewof cciSelected = Inputs.checkbox(cciValues.map(d=>d.condition), {
  label: "Comorbidities",
  multiple: true
})
//html`Calculated CCI <strong>${cciTotal}</strong>.`

html`
<style>
  .hello { border: solid #D3D3D3 3px; padding: 4px; border-radius: 7px }
</style>
`

total = {
  let intercept = -1.8391;
  let time1_coef = 0.0013;
  let time2_coef = -0.0351;
  let abx_last_90_coef = 1.2767;
  let cci_coef =  0.4636;
  let currentTime = new Date();
  let total = intercept + cciTotal * cci_coef;
  let time_culture_use =  Math.abs(timeculture - currentTime)/1000/60/60/24;
  total = total + time1_coef * time_culture_use + time2_coef *time_culture_use
  let ageCheck = ageInput;
  let sexCheck = sexInput;
  let sourceCheck = sourceLocationName;
  let sourceGeo = sourceGeography + careLocationName;
  if (abx_last_90 > 0) {
    total = total + abx_last_90_coef ;
  }
  let odds = 2.61**total;
  let prob = odds/(1+odds)*100;
  
  if(prob < 5){
  prob = '< 5'
  }
  
  return prob.toLocaleString(undefined, {maximumSignificantDigits: 3});
}

viewof calculateESbl = Inputs.button("Calculate Risk", {value: null, reduce: () => total})

checkInputs() ? html`<span style="font-size: 1.75em">The probability the infection is caused by ESBL-producing <em>E. coli</em> or <em>K. pneumoniae</em> is <strong>${calculateESbl}</strong>%</span>` : html`<span>Click <em>"Calculate Risk"</em></span>`

function checkNull(obj){
  return Object.is(obj, null);
}

function checkInputs(){
  let inputList = [checkNull(sexInput),
                   checkNull(careLocationName), 
                   checkNull(sourceGeography),checkNull(sourceLocationName), 
                   checkNull(calculateESbl) ];
  return inputList.every( v=> v === false);
}

d3 = require("d3-array@2", "d3-dsv@2")

Citation

BibTeX citation:

@article{j.stone2023,
  author = {Tyler J. Stone and Michael E. DeWitt and James W. Johnson
    and James R. Beardsley and Iqra Munawar and Elizabeth Palavecino and
    Vera P. Luther and Christopher A. Ohl and John C. Williamson},
  title = {Analysis of Infections Among Patients with Historical Culture
    Positive for Extended-Spectrum Beta-Lactamase {(ESBL)–producing}
    {Escherichia} Coli or {Klebsiella} Pneumoniae: {Is} {ESBL-targeted}
    Therapy Always Needed?},
  journal = {Antimicrobial Stewardship \& Healthcare Epidemiology},
  volume = {3},
  number = {1},
  date = {2023},
  url = {https://esblrisk.com/},
  doi = {10.1017/ash.2022.363},
  issn = {2732-494X},
  langid = {en}
}

For attribution, please cite this work as:

Tyler J. Stone, Michael E. DeWitt, James W. Johnson, James R. Beardsley, Iqra Munawar, Elizabeth Palavecino, Vera P. Luther, Christopher A. Ohl, and John C. Williamson. 2023. “Analysis of Infections Among Patients with Historical Culture Positive for Extended-Spectrum Beta-Lactamase (ESBL)–Producing Escherichia Coli or Klebsiella Pneumoniae: Is ESBL-Targeted Therapy Always Needed? .” Antimicrobial Stewardship & Healthcare Epidemiology 3 (1). https://doi.org/10.1017/ash.2022.363.