A new simplified predictive model for mortality in methicillin-resistant Staphylococcus aureus bacteremia

Jorgensen, Sarah C J; Lagnf, Abdalhamid M; Bhatia, Sahil; Rybak, Michael J.

doi:10.1007/s10096-018-03464-0

Cited by 5 publications

(6 citation statements)

References 38 publications

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“…Important clinical metrics of organ failure (SOFA score) and sepsis (SEPSIS‐3) were not available to evaluate relationships between the biomarker panel and a broader range of disease severity. We observed that serum biomarkers were superior to other available clinical comorbidity risk factors but not APACHE II severity scores or age; while APACHE has been assessed as superior to Pitt bacteraemia score in predicting SAB mortality, the Pitt bacteraemia scores, Charlson comorbidity index scores and the recently described MRSAB risk score were not available for this cohort for comparative analysis . Future cohorts with longitudinal sampling would allow evaluation of whether the duration of high levels of the biomarkers associated with endovascular infections could be used to monitor clearance of infection foci in clinical trials.…”

Section: Discussionmentioning

confidence: 83%

“…We observed that serum biomarkers were superior to other available clinical comorbidity risk factors but not APACHE II severity scores or age; while APACHE has been assessed as superior to Pitt bacteraemia score in predicting SAB mortality, the Pitt bacteraemia scores, Charlson comorbidity index scores and the recently described MRSAB risk score were not available for this cohort for comparative analysis. [36][37][38] Future cohorts with longitudinal sampling would allow evaluation of whether the duration of high levels of the biomarkers associated with endovascular infections could be used to monitor clearance of infection foci in clinical trials. The 90-day window for assessment of mortality could impair the ability of clinicians to discriminate between attributable mortality and nonattributable mortality, and mortality may be less strongly connected to initial biomarker levels.…”

Section: Clinical Endocarditismentioning

confidence: 99%

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Risk stratification biomarkers for Staphylococcus aureus bacteraemia

Cao¹,

Guimaraes²,

Peck³

et al. 2020

Clin & Trans Imm

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Objectives To identify risk stratification biomarkers to enrich for the subset of Staphylococcus aureus bacteraemia patients who develop deep‐seated tissue infections with high morbidity and mortality to guide clinical trial enrolment and clinical management. Methods We evaluated the prognostic value of eight biomarkers for persistent bacteraemia, mortality and endovascular infection foci in a validation cohort of 160 patients with S. aureus bacteraemia enrolled consecutively over 3 years. Results High levels of IL‐17A, IL‐10 or soluble E‐selectin at bacteraemia diagnosis correlated with the duration of positive blood cultures. When thresholds defined in an independent cohort were applied, these biomarkers were robust predictors of persistent bacteraemia or endovascular infection. High serum levels of IL‐17A and IL‐10 often preceded the radiographic diagnosis of infective endocarditis, suggesting potential utility for prioritising diagnostic radiographic imaging. High IL‐8 was prognostic for all‐cause mortality, while IL‐17A and IL‐10 were superior to clinical metrics in discriminating between attributable mortality and non‐attributable mortality. High IL‐17A and IL‐10 identified more patients who developed microbiological failure or mortality than were identified by infective endocarditis diagnosis. Conclusion These biomarkers offer potential utility to identify patients at risk of persistent bacteraemia to guide diagnostic imaging and clinical management. Low biomarker levels could be used to rule out the need for more invasive TEE imaging in patients at lower risk of infective endocarditis. These biomarkers could enable clinical trials by enriching for patients with the greatest need for novel therapies.

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Section: Discussionmentioning

confidence: 83%

Section: Clinical Endocarditismentioning

confidence: 99%

Risk stratification biomarkers for Staphylococcus aureus bacteraemia

Cao¹,

Guimaraes²,

Peck³

et al. 2020

Clin & Trans Imm

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“…We included 89 studies in the analysis, with a total of 132 582 patients (50 258 female [37.9%], 82 324 male [62.1%]) (Table). All data on mortality by sex were from observational studies: 88 of 89 cohort studies and 1 post hoc analysis of a randomized clinical trial. Mortality was most frequently assessed at 28 to 30 days (54 of 89 studies [61%]).…”

Section: Resultsmentioning

confidence: 99%

Female Sex and Mortality in Patients with Staphylococcus aureus Bacteremia

Westgeest,

Lambregts,

Ruffin

et al. 2024

JAMA Netw Open

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ImportanceStaphylococcus aureus is the leading cause of death due to bacterial bloodstream infection. Female sex has been identified as a risk factor for mortality in S aureus bacteremia (SAB) in some studies, but not in others.ObjectiveTo determine whether female sex is associated with increased mortality risk in SAB.Data SourcesMEDLINE, Embase, and Web of Science were searched from inception to April 26, 2023.Study SelectionIncluded studies met the following criteria: (1) randomized or observational studies evaluating adults with SAB, (2) included 200 or more patients, (3) reported mortality at or before 90 days following SAB, and (4) reported mortality stratified by sex. Studies on specific subpopulations (eg, dialysis, intensive care units, cancer patients) and studies that included patients with bacteremia by various microorganisms that did not report SAB-specific data were excluded.Data Extraction and SynthesisData extraction and quality assessment were performed by 1 reviewer and verified by a second reviewer. Risk of bias and quality were assessed with the Newcastle-Ottawa Quality Assessment Scale. Mortality data were combined as odds ratios (ORs).Main Outcome and MeasuresMortality at or before 90-day following SAB, stratified by sex.ResultsFrom 5339 studies retrieved, 89 were included (132 582 patients; 50 258 female [37.9%], 82 324 male [62.1%]). Unadjusted mortality data were available from 81 studies (109 828 patients) and showed increased mortality in female patients compared with male patients (pooled OR, 1.12; 95% CI, 1.06-1.18). Adjusted mortality data accounting for additional patient characteristics and treatment variables were available from 32 studies (95 469 patients) and revealed a similarly increased mortality risk in female relative to male patients (pooled adjusted OR, 1.18; 95% CI, 1.11-1.27). No evidence of publication bias was encountered.Conclusions and RelevanceIn this systematic review and meta-analysis, female patients with SAB had higher mortality risk than males in both unadjusted and adjusted analyses. Further research is needed to study the potential underlying mechanisms.

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“…judgment. [18][19][20] In patients with BSIs caused by Staphylococcus aureus, qpitt has a good predictive value for the 28-day mortality and 14-day mortality of these patients, and the AUROC are 0.8 and 0.81, 19 respectively. For the patients with carbapenem-resistant Enterobacter infection treated with ceftazidime/avibactam, the study of Jorgensen 18 showed that the predictive value of qpitt for the 30-day mortality was poor, and the AUROC was only 0.6847.…”

mentioning

confidence: 99%

“…[18][19][20] In patients with BSIs caused by Staphylococcus aureus, qpitt has a good predictive value for the 28-day mortality and 14-day mortality of these patients, and the AUROC are 0.8 and 0.81, 19 respectively. For the patients with carbapenem-resistant Enterobacter infection treated with ceftazidime/avibactam, the study of Jorgensen 18 showed that the predictive value of qpitt for the 30-day mortality was poor, and the AUROC was only 0.6847. However, in patients with carbapenem-resistant Enterobacter infection, Henderson's study showed that qpitt ≥2 had a good predictive value for 14-day mortality, with a sensitivity of 91% and a specificity of 65%, even if the patient is not with BSI, qpitt ≥2 also has similar predictive value, with a sensitivity of 95% and a specificity of 64%.…”

mentioning

confidence: 99%

Predictive Value of a Quick Pitt Bacteremia Score for Prognosis of Patients with Bloodstream Infection Secondary to Urinary Tract Infection: A Retrospective Cohort Study

Li¹,

Wang²,

Wang³

et al. 2022

IDR

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Purpose To analyze the effect of a quick Pitt bacteremia score (qpitt) on the prognosis of patients with bloodstream infection (BSI) secondary to urinary tract infection (UTI) and to further explore its use in aiding appropriate selection of initial antibiotic treatment. Methods Medical records of patients with BSIs secondary to UTIs who were admitted to our hospital from January 2018 to December 2020 were retrospectively collected. To screen for independent risk factors, logistic analysis was conducted on statistically significant variables. The receiver operating characteristic (ROC) curve was drawn with prognosis and death as the state variables to evaluate the predictive value. Patients were grouped by qpitt 2-point cutoff, to explore the impact of initial antimicrobial treatment regimens on poor prognosis and death in different subgroups. Poor prognosis was defined as a hospital length of stay (HLOS) ≥14 days or death within 28 days from BSI onset (ie, 28-day death). Results A total of 266 patients were included in this study. In BSIs secondary to UTIs, we observed a pathogenic composition of 77.44% Gram-negative bacteria, 19.55% Gram-positive bacteria, and 3.01% fungi. The qpitt had poor predictive value for poor prognosis [area under ROC (AUROC) = 0.653, p < 0.001], while it had a high predictive value for death (AUROC = 0.890, p < 0.001). For patients with a qpitt ≥2, the poor prognosis and death rates of patients who were initially treated with carbapenem antibiotics were lower (p < 0.01). In comparison, initial treatment with carbapenem antibiotics had no significant effect on prognosis and death rates in patients with qpitt <2 (p > 0.1). Conclusion The qpitt is highly predictive for death in patients with BSIs secondary to UTIs and can be used to inform first-line antibiotic treatment strategy.

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A new simplified predictive model for mortality in methicillin-resistant Staphylococcus aureus bacteremia

Cited by 5 publications

References 38 publications

Risk stratification biomarkers for Staphylococcus aureus bacteraemia

Risk stratification biomarkers for Staphylococcus aureus bacteraemia

Female Sex and Mortality in Patients with Staphylococcus aureus Bacteremia

Predictive Value of a Quick Pitt Bacteremia Score for Prognosis of Patients with Bloodstream Infection Secondary to Urinary Tract Infection: A Retrospective Cohort Study

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