Comparison of censored regression and standard regression analyses for modeling relationships between antimicrobial susceptibility and patient- and institution-specific variables

Antimicrob Agents Chemother. 2006 Jan;50(1):62-7. doi: 10.1128/AAC.50.1.62-67.2006.

Abstract

In order to identify patients likely to be infected with resistant bacterial pathogens, analytic methods such as standard regression (SR) may be applied to surveillance data to determine patient- and institution-specific factors predictive of an increased MIC. However, the censored nature of MIC data (e.g., MIC < or = 0.5 mg/liter or MIC > 8 mg/liter) imposes certain limitations on the use of SR. In order to investigate the nature of these limitations, simulations were performed to compare a regression tailored for censored data (censored regression [CR]) and one tailored for an SR. By using a model relating piperacillin-tazobactam MICs against Enterobacter spp. to patient age and hospital bed capacity, 200 simulations of 500 isolates were performed. Various MIC censoring patterns were imposed by using 26 left- or right-censored (L,R) pairs (i.e., MICs < or = 2 mg/liter(L) [2L] or MICs > 2 mg/liter(R) [2R], respectively). Data were fit by CR and SR for which censored MICs were either (i) excluded, (ii) replaced by 2L or 2R, or (iii) replaced by 2(L - 1) or 2(R + 1). Total censoring for the 26 pairs ranged from 7 to 86%. By CR, deviations of average parameter estimates from the true parameter values were <0.10 log2 (mg/liter) for all parameters for each of the 26 pairs. By SR, these deviations were >0.10 log2 (mg/liter) for at least 18 of the 26 pairs for all but one parameter. Two-standard-error confidence intervals for individual parameters contained as little as 0% of cases for all SR approaches but > or = 91.5% of cases for the CR approach. When censored MIC data are modeled, CR may reduce or eliminate biased parameter estimates obtained by SR.

Publication types

  • Comparative Study

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Anti-Infective Agents / pharmacology
  • Computer Simulation*
  • Drug Resistance, Bacterial / physiology
  • Enterobacter / drug effects
  • Humans
  • Linear Models
  • Microbial Sensitivity Tests / standards
  • Microbial Sensitivity Tests / statistics & numerical data*
  • Models, Biological*
  • Models, Genetic
  • Predictive Value of Tests
  • Regression Analysis
  • Research Design

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents