ArticleFrontiers in cellular and infection microbiology2026
Prediction of vancomycin-resistant phenotype in ICU-onset sterile-site
Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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 Results: Among 811 admissions (507 resistant isolates; prevalence, 62.5%), Elastic Net achieved a validation AUROC of 0.835 (95% CI, 0.778-0.889) and calibration slope of 0.91 (0.71-1.18). Tree-model AUROCs were 0.842-0.855; non-significant pairwise DeLong tests were evidence insufficient to detect differences, not evidence of equivalence. Removing both species indicators reduced AUROC to 0.657 (DeLong Conclusions: The model predicts isolate resistance phenotype, not adjudicated infection, and is not a stand-alone treatment rule. These estimates are specific to a single-center cohort with high VRE prevalence. Independent external validation, local recalibration, clinical adjudication, and periodic updating are prerequisites for use.
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