Bloodstream Infection-Associated Sepsis and Septic Shock in Critically Ill Adults: A Population-Based Study

Laupland, Kevin B.; Davies, H. Dele; Church, Deirdre L.; Louie, Thomas; Dool, J. S.; Zygun, David; Doig, Christopher J.

doi:10.1007/s15010-004-3064-6

Cited by 70 publications

(49 citation statements)

References 28 publications

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“…Several other authors have also investigated this, with some finding that bacteraemia does not increase mortality [3,14,18] and others concluding it does [4,5,19]. This may be because the observed impact of bacteraemia varies with study population and setting.…”

Section: Discussionmentioning

confidence: 99%

“…We also investigated the relationship between SIRS status and blood culture result, as prior work in the non-ICU [3,9,10] setting has suggested that the presence of SIRS is closely linked with bacteraemia and as such might be utilised to be used to predict the presence of bacteraemia and thus avoid unnecessary blood cultures in patients who are unlikely to be bacteraemic [6].…”

Section: Discussionmentioning

confidence: 99%

“…There are conflicting reports in the literature concerning the outcomes of ICU patients with bacteraemia; for example, a Canadian study demonstrated that patients presenting to the ICU with bacteraemia did not have increased mortality compared to those without (OR 1.1 95% CI 0.7-1.8) [3]. This contrasts with studies by Prowle et al and Lambert et al which found that bacteraemia was independently associated with an increase in mortality rate in ICU patients of three and two-four fold respectively [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…The ability to simply and accurately assess the risk of bacteraemia would be useful when deciding whether to take blood cultures. Previous work has indicated that the Systemic Inflammatory Response Syndrome (SIRS) is a sensitive indicator of the presence of bacteraemia in general medical patients [3,9,10].…”

Section: Introductionmentioning

confidence: 99%

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Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome

Brooks

Smith

Young

et al. 2016

American Journal of Infection Control

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Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome. American Journal of Infection Control, 44(11), pp. 1291Control, 44(11), pp. -1295Control, 44(11), pp. . (doi:10.1016Control, 44(11), pp. /j.ajic.2016 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it. TitleMortality in intensive care -the impact of bacteremia and the utility of SIRS. 2 Abstract ObjectiveTo determine the impact of bacteraemia on ICU mortality and develop a bacteremia prediction tool using Systemic Inflammatory Response Syndrome (SIRS) criteria. ParticipantsPatients aged >18 who had blood cultures taken in the ICU 1 st January 2011-31 st December 2013. DesignAll patients meeting the above criteria were identified from microbiology department records of Glasgow Royal Infirmary, Scotland. Clinical and outcome data were gathered from ICU records. Patients with clinically significant bacteraemia were matched to controls using propensity scores. SIRS criteria were gathered and used to create decision rules to predict the absence of bacteraemia. Main outcome measuresMortality at ICU discharge. Sensitivity and accuracy of prediction of blood culture status by SIRS decision rule. ResultsOne hundred patients had a clinically significant positive blood culture and were matched to 100 controls. Bacteraemic patients had higher ICU mortality (OR 2.35 p=0.001) and longer ICU stay (17.0 vs. 7.8 days, p=<0.001). Of 1548 blood culture episodes, 1274 met ≥2 SIRS criteria (106 significant positive cultures, 1168 negative cultures). There was no association between SIRS criteria and positive blood cultures (p=0.11). A decision rule using three SIRS criteria had optimal predictive performance (sensitivity 56%; specificity 50%) but had low accuracy. ConclusionICU patients with bacteraemia have increased mortality and length of ICU stay. SIRS criteria cannot be used to identify patients at low risk of bacteraemia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome

Brooks

Smith

Young

et al. 2016

American Journal of Infection Control

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“…[9] Although our understanding of the complex pathophysiological alterations that occur in severe sepsis and septic shock has increased greatly as a result of recent clinical and preclinical studies, mortality associated with the disorder remains unacceptably high, ranging from 30% to 50%. [10][11][12][13] The rapid diagnosis and effective management of sepsis is critical to successful treatment. [14] The Surviving Sepsis Campaign, an initiative of the European Society of Intensive Care Medicine (ESICM), the International Sepsis Forum (ISF), and the Society of Critical Care Medicine, was developed to improve the management, diagnosis, and treatment of sepsis.…”

Section: Discussionmentioning

confidence: 99%

Effects of high-volume hemofiltration on alveolararterial oxygen exchange in patients with refractory septic shock

Ren¹

2011

World J Emerg Med

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Does This Adult Patient With Suspected Bacteremia Require Blood Cultures?

Coburn

Morris²,

Tomlinson³

et al. 2012

JAMA

283

230

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ContextClinicians order blood cultures liberally among patients in whom bacteremia is suspected, though a small proportion of blood cultures yield true-positive results. Ordering blood cultures inappropriately may be both wasteful and harmful.Objective To review the accuracy of easily obtained clinical and laboratory findings to inform the decision to obtain blood cultures in suspected bacteremia. Data Sources and Study SelectionA MEDLINE and EMBASE search (inception to April 2012) yielded 35 studies that met inclusion criteria for evaluating the accuracy of clinical variables for bacteremia in adult immunocompetent patients, representing 4566 bacteremia and 25 946 negative blood culture episodes.Data Extraction Data were extracted to determine the prevalence and likelihood ratios (LRs) of findings for bacteremia. Data SynthesisThe pretest probability of bacteremia varies depending on the clinical context, from low (eg, cellulitis: 2%) to high (eg, septic shock: 69%). Elevated temperatures alone do not accurately predict bacteremia (for Ն38°C [Ͼ100.3°F], LR, 1.9 [95% CI, 1.4-2.4]; for Ն38.5°C [Ͼ101.2°F], LR, 1.4 [95% CI, 1.1-2.0]), nor does isolated leukocytosis (LR, Ͻ1.7). The severity of chills graded on an ordinal scale (shaking chills, LR, 4.7; 95% CI, 3.0-7.2) may be more useful. Both the systemic inflammatory response syndrome (SIRS) and a multivariable decision rule with major and minor criteria are sensitive (but not specific) predictors of bacteremia (SIRS, negative LR, 0.09 [95% CI, 0.03-0.26]; decision rule, negative LR, 0.08 [95% CI, 0.04-0.17]).Conclusions Blood cultures should not be ordered for adult patients with isolated fever or leukocytosis without considering the pretest probability. SIRS and the decision rule may be helpful in identifying patients who do not need blood cultures. These conclusions do not apply to immunocompromised patients or when endocarditis is suspected.

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Bloodstream Infection-Associated Sepsis and Septic Shock in Critically Ill Adults: A Population-Based Study

Abstract: Knowledge of the epidemiology of these syndromes is important for assessing the burden of disease and providing background information for investigating new therapies.

Cited by 70 publications

References 28 publications

Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome

Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome

Effects of high-volume hemofiltration on alveolararterial oxygen exchange in patients with refractory septic shock

Does This Adult Patient With Suspected Bacteremia Require Blood Cultures?

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