Background
Methods
Sample selection
Categorisation
Data collection
Demographics
Symptomology and portal of entry
Laboratory test factors
Statistical analysis
Data presentation
Univariate analysis- stage 1
Receiver operating characteristic (ROC) curve analysis- stage 2
Multiple logistic regression- stage 3
Results
Description of the cohort
Demographics
Demographic | Total | Uncomplicated | Complicated | Comparisona | ||
---|---|---|---|---|---|---|
% [n = 158] | % [n = 51] | % [n = 107] | Crude OR | 95% CI | p-value | |
Age median (IQR) | 68.5 (29.0) | 59.0 (29.0) | 72.0 (26.0) | 1.03 | (1.01, 1.05) | 0.003 |
Gender | ||||||
Female | 39.2 [62] | 41.2 [21] | 38.3 [41] | 0.89 | (0.45, 1.75) | 0.731 |
Male | 60.8 [96] | 58.8 [30] | 61.7 [66] | |||
CACI median (IQR) | 5.0 (6.0) | 5.0 (6.0) | 5.0 (6.0) | 1.03 | (0.93, 1.13) | 0.597 |
Immunosuppression | 13.2 [21] | 17.6 [9] | 11.2 [12] | 0.59 | (0.23, 1.51) | 0.269 |
Diabetes | 32.3 [51] | 37.3 [19] | 29.9 [32] | 0.72 | (0.36, 1.45) | 0.357 |
Injecting Drug User | 9.5 [15] | 13.7 [7] | 7.5 [8] | 0.51 | (0.17, 1.49) | 0.217 |
Skin conditionsb | 3.8 [6] | 7.8 [4] | 1.9 [2] | 0.22 | (0.04, 1.27) | 0.090 |
Haemodialysis | 4.4 [7] | 11.8 [6] | 0.9 [1] | 0.07 | (0.01, 0.60) | 0.016 |
Self-reported symptomology
Symptoms | Total | Uncomplicated | Complicated | Comparisona | ||
---|---|---|---|---|---|---|
% [n = 158] | % [n = 51] | % [n = 107] | Crude OR | 95% CI | p-value | |
Fever | 57.6 [91] | 58.8 [30] | 57.0 [61] | 0.93 | (0.47, 1.83) | 0.829 |
Rigors | 32.2 [51] | 43.1 [22] | 27.1 [29] | 0.49 | (0.24, 0.99) | 0.046 |
Nausea | 38.0 [60] | 47.1 [24] | 33.6 [36] | 0.57 | (0.29, 1.13) | 0.106 |
Lethargy | 19.6 [31] | 19.6 [10] | 19.6 [21] | 1.00 | (0.43, 2.32) | 0.998 |
Painb | 65.8 [104] | 52.7 [32] | 67.3 [72] | 1.22 | (0.61, 2.45) | 0.574 |
Portal of entry
Portal of entry variables | Total | Uncomplicated | Complicated | Comparisona | ||
---|---|---|---|---|---|---|
% [n = 158] | % [n = 51] | % [n = 107] | Crude OR | 95% CI | p-value | |
Skin/soft tissue infections | 32.9 [52] | 49.0 [25] | 25.2 [27] | 0.35 | (0.17, 0.71) | 0.003 |
Diabetic foot ulcer | 8.9 [14] | 8.9 [10] | 3.7 [4] | 0.16 | (0.05, 0.54) | 0.003 |
Pneumonia | 2.5 [4] | 2.0 [1] | 2.8 [3] | 1.44 | (0.15, 14.22) | 0.754 |
Unknown | 36.1 [57] | 15.7 [8] | 45.8 [49] | 4.54 | (1.95, 10.57) | < 0.001 |
Indwelling medical devicesb | 15.8 [25] | 9.8 [5] | 18.7 [20] | 2.11 | (0.75, 6.00) | 0.159 |
Injecting drug use | 3.8 [6] | 3.9 [2] | 3.7 [4] | 0.95 | (0.17, 5.37) | 0.955 |
Microbiological and laboratory assessment
Laboratory Result | Total | Uncomplicated | Complicated | Comparisona | ||
---|---|---|---|---|---|---|
% [n = 158] | % [n = 51] | % [n = 107] | Crude OR | 95% CI | p-value | |
Microbiological tests | ||||||
PSSA | 18.4 [29] | 17.6 [9] | 18.7 [20] | 1.07 | (0.45, 2.56) | 0.874 |
MSSA | 74.1 [117] | 74.5 [38] | 73.8 [79] | 0.97 | (0.45, 2.07) | 0.928 |
nm-MRSA | 5.1 [8] | 5.9 [3] | 4.7 [5] | 0.78 | (0.18, 3.42) | 0.746 |
MRSA | 2.5 [4] | 2.0 [1] | 2.8 [3] | 1.44 | (0.76, 14.22) | 0.754 |
Poly-microbial | 10.8 [17] | 17.6 [9] | 7.5 [8] | 0.38 | (0.14, 1.04) | 0.061 |
Blood tests | ||||||
C-Reactive protein concentration median (IQR) | 144.0 (141.0) [139] | 127.0 (129.7) [48] | 160.0 (145.6) [91] | 1.01 | (1.00, 1.01) | 0.007 |
Platelet cell count median (IQR) | 177.5 (138.8) [150] | 190.0 (126.5) [49] | 175.0 (143.5) [101] | 1.00 | (0.99, 1.00) | 0.346 |
White cell count median (IQR) | 11.4 (7.8) [150] | 10.0 (6.2) [49] | 12.1 (9.5) [101] | 1.07 | (1.01, 1.13) | 0.027 |
Lymphocyte cell count median (IQR) | 0.8 (0.8) [150] | 0.8 (0.85) [49] | 0.8 (0.7) [101] | 0.85 | (0.54, 1.33) | 0.477 |
Neutrophil cell count median (IQR) | 9.1 (6.6) [150] | 7.4 (6.2) [49] | 9.8 (7.5) [101] | 1.05 | (0.98, 1.13) | 0.146 |
C-reactive protein concentration over 161 mg/L | 40.3 [56] | 22.9 [11] | 49.5 [45] | 3.29 | (1.50, 7.24) | 0.003 |
White blood cell count over 14.85 × 109/L | 30.7 [46] | 16.3 [8] | 37.6 [38] | 3.09 | (1.31, 7.29) | 0.01 |
Neutrophil cell count over 9.25 × 109/L | 48.7 [73] | 36.7 [18] | 54.5 [55] | 2.06 | (1.02, 4.15) | 0.043 |
Multiple logistic regression analysis
Covariates [n = 139] | ORadj | 95% CI | p-value | 95% CIa | p-value |
---|---|---|---|---|---|
Age | 1.03 | (1.01, 1.06) | 0.013 | (1.01, 1.06) | 0.014 |
Haemodialysis | 0.09 | (0.01, 0.97) | 0.047 | (0.01, 0.71) | 0.023 |
Nausea | 0.44 | (0.18, 1.07) | 0.070 | (0.18, 1.07) | 0.069 |
Diabetic foot ulcer entry point | 0.12 | (0.02, 0.62) | 0.012 | (0.02, 0.77) | 0.025 |
Unknown entry point | 3.94 | (1.31, 11.84) | 0.015 | (1.33, 11.62) | 0.013 |
Indwelling medical device entry point | 4.58 | (1.21, 17.26) | 0.025 | (1.14, 18.35) | 0.032 |
CRP over 161 mg/L on day of admission | 3.56 | (1.29, 9.79) | 0.014 | (1.22, 10.40) | 0.020 |
White blood cell count over 14.85 × 109 cells/L on day of admission | 2.93 | (0.89, 9.69) | 0.077 | (0.93, 9.28) | 0.067 |
Discussion
StudyFirst Author | Setting | Population | Cut-off [mg/L] | Poor outcome | [Ref]. |
---|---|---|---|---|---|
Horino | RetrospectiveSingle centre n = 73 | AdultMSSA-SAB | > 30.0 | Metastatic infection | [50] |
Holmes | Prospective Multi-centren = 222 | Adult SAB | > 250.0 | 30-day Treatment failure | [32] |
Pravin | ProspectiveCross-sectional Single centren = 75 | Neonates,All-causeSepsis symptoms | > 30.0 | Sepsis | [51] |
Bernstein | Retrospective, Single centren = 109 | PaediatricS. aureusSeptic arthritis | > 13.7 | MRSA Septic arthritis | [52] |
Bouchard | Retrospective, Single centren = 183 | PaediatricAll-causeSeptic arthritis | < 20.0 | Not reliable as a marker for clearance of infection | [53] |
Tascini | RetrospectiveMulti-centren = 236 | AdultAll-cause Infective endocarditis | > 130.0> 850.0 | -S. aureus infective endocarditis-Death | [54] |
Molkanen | ProspectiveMulti-centren = 430 | Adult SAB | Day 4: > 103.0Day 14: > 61.0Day of diagnosis: > 108.0Day 14: > 22.0 | -death-death-deep infection-deep infection | [55] |
Lin | RetrospectiveSingle centren = 108 | All ages,All-cause Osteomyelitis | > 5.0> 8.0 | -Prosthesis related-osteomyelitis recurrence-Prosthesis unrelated-osteomyelitis recurrence | [56] |
Chiappini | RetrospectiveSingle centren = 121 | PaediatricAll-causeAcute haematogenous osteomyelitis | > 10.0 | Complicated acute haematogenous osteomyelitis | [57] |
Tang | RetrospectiveSingle centren = 825 | AdultAll-cause bacteraemia | No cut-off | Distinguishes positive and negative cultures,Distinguishes between gram positive, negative and candidaDistinguishes between species | [58] |
Garcia del Pozo | RetrospectiveSingle centren = 116 | AdultAll-causeLong boneosteomyelitis | NA | Relapse recurrent osteomyelitis | [59] |
Botheras | ProspectiveSingle centren = 158 | Adult community-onset SAB | > 161.0 | Complicated SAB |