Erschienen in:
08.02.2019 | Original Paper
Derivation of a quick Pitt bacteremia score to predict mortality in patients with Gram-negative bloodstream infection
verfasst von:
Sarah E. Battle, Matthew R. Augustine, Christopher M. Watson, P. Brandon Bookstaver, Joseph Kohn, William B. Owens, Larry M. Baddour, Majdi N. Al-Hasan
Erschienen in:
Infection
|
Ausgabe 4/2019
Einloggen, um Zugang zu erhalten
Abstract
Purpose
This retrospective cohort study derived a “quick” version of the Pitt bacteremia score (qPitt) using binary variables in patients with Gram-negative bloodstream infections (BSI). The qPitt discrimination was then compared to quick sepsis-related organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS).
Methods
Hospitalized adults with Gram-negative BSI at Palmetto Health hospitals in Columbia, SC, USA from 2010 to 2013 were identified. Multivariate Cox proportional hazards regression was used to determine variables associated with 14-day mortality.
Results
Among 832 patients with Gram-negative BSI, median age was 65 years and 449 (54%) were women. After adjustments for age and Charleston comorbidity score, all five components of qPitt were independently associated with mortality: temperature < 36 °C [hazard ratio (HR) 3.02, 95% confidence interval (CI) 1.95–4.62], systolic blood pressure < 90 mmHg or vasopressor use (HR 2.40, 95% CI 1.37–4.13), respiratory rate ≥ 25/min or mechanical ventilation (HR 3.01, 95% CI 1.81–5.14), cardiac arrest (HR 5.35, 95% CI 2.81–9.43), and altered mental status (HR 3.99, 95% CI 2.44–6.80). The qPitt had higher discrimination to predict mortality [area under receiver operating characteristic curve (AUROC) 0.85] than both qSOFA (AUROC 0.77, p < 0.001) and SIRS (AUROC 0.63, p < 0.001). There was a significant difference in mortality between appropriate and inappropriate empirical antimicrobial therapy in patients with qPitt ≥ 2 (24% vs. 49%, p < 0.001), but not in those with qPitt < 2 (3% vs. 5%, p = 0.36).
Conclusions
The qPitt had good discrimination in predicting mortality following Gram-negative BSI and identifying opportunities for improved survival with appropriate empirical antimicrobial therapy.