Influence of referral bias on the clinical characteristics of patients with Gram-negative bloodstream infection

Al-Hasan, Majdi N.; Eckel‐Passow, Jeanette E.; Baddour, Larry M.

doi:10.1017/s095026881100001x

Cited by 36 publications

(18 citation statements)

References 33 publications

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“…Literature reported advanced age(>60 years) as a risk factor for urinary source bacteremia which they attributed to increased incidence of benign prostatic hyperplasia in elderly men and multiple comorbidities seen in elderly population. 13 A slight male (59%) preponderance was observed in the present studythough not statistically significant (p value -0.179) which confirms with mostother studiesnot identifying gender as a risk factor for urinary source bacteremia. 2,12 Male predominance in bacteremia group in this study may be attributed to benign prostatic hyperplasia.…”

Section: Discussionsupporting

confidence: 87%

“…Mean age of the study population was 55 years which was similar (55-70 years) to other studies. 3,13 However, we did not get any association between bacteremia and advanced age (more than 60 years). In fact unlike other studies, the present study reports a marginally higher proportion of bacteremia among the younger individuals although was not statistically significant.…”

Section: Discussioncontrasting

confidence: 60%

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A study of risk factors for bacteremia caused by urinary tract infections

et al. 2018

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Background: Urinary tract infections are not only one of the most common infections, but also one of the most common sources of bacteremia in both the general population and hospitalized patients.Aims and Objectives: The objective of this study was to identify risk factors for bacteremia caused by urinary tract infections.Materials and Methods: This was a prospective case control study conducted from October 2012 to July 2014in a tertiary care teaching hospital in southern India. Urinary tract infections were diagnosed based on the CDC criteria.Patients witha set of blood cultures and urine culture isolating same organism were grouped as cases while patients with urine culture alone isolating organism with sterile blood cultures were identified as controls.Results: Out of the 198 patientsin the study, 66 were cases while 132 were controls. E coli was the most organism isolated (81% of cases and 66% of controls). Risk factors for bacteremia based on univariate and multivariate analysis were diabetes mellitus with uncontrolled sugars (univariate: p=0.001; OR=5.250 [2.044-13.582]; and multivariate: p=0.01; OR= 6.023 [1.52-23.51]) and pyelonephritis (univariate: p=0.001; OR=6.56 [2.87-1.48]; and multivariate: p=0.047; OR=4.95 [1.02-24.12]).Conclusion: Upper UTI and complicated UTI patients should be evaluated for bacteremia since prompt and targeted treatment may be required.Asian Journal of Medical Sciences Vol.9(5) 2018 25-30

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 60%

A study of risk factors for bacteremia caused by urinary tract infections

et al. 2018

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“…As the derivation cohort for the Gram‐negative BSI risk score was a referral rather than a population‐based cohort, patients >80 years of age were under‐represented, as previously demonstrated . This is probably the explanation for the lack of an age effect on mortality in this study.…”

Section: Discussionmentioning

confidence: 62%

Predictive scoring model of mortality in Gram-negative bloodstream infection

Al-Hasan

Lahr

Eckel‐Passow

et al. 2013

Clinical Microbiology and Infection

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Mortality is a well-recognized complication of Gram-negative bloodstream infection (BSI). The aim of this study was to develop a model to predict mortality in patients with Gram-negative BSI by using the Pitt bacteraemia score (PBS) and other clinical and laboratory variables. A cohort of 683 unique adult patients who were followed for at least 28 days after admission to Mayo Clinic Hospitals with Gram-negative BSI from 1 January 2001 to 31 October 2006 and who received clinically predefined appropriate empirical antimicrobial therapy was retrospectively identified. Multivariable logistic regression was used to identify independent risk factors for 28-day all-cause mortality. Regression coefficients from a multivariable model were used to develop a risk score to predict mortality following Gram-negative BSI. Malignancy (OR 3.48, 95% CI 1.94-6.22), liver cirrhosis (OR 5.42, 95% CI 2.52-11.65), source of BSI other than urinary tract or central venous catheter infection (OR 5.54, 95% CI 2.42-12.69), and PBS (OR 1.98, 95% CI 0.92-4.25 for PBS of 2-3 and OR 6.42, 95% CI 3.11-13.24 for PBS ≥4) were identified as independent risk factors for 28-day mortality in patients with Gram-negative BSI. A risk-score model was created by adding points for each independent risk factor, and had a c-statistic of 0.84. Patients with risk scores of 0, 4, 8, 12 and 16 had estimated 28-day mortality rates of approximately 0%, 3%, 14%, 45%, and 81%, respectively. The Gram-negative BSI risk score described herein estimated mortality risk with high discrimination in patients with Gram-negative BSI who received clinically adequate empirical antimicrobial therapy.

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“…In addition, the participating centres in such surveillance studies are not randomly selected, and therefore do not fairly represent the entire country. Estimates from population-based studies are probably more accurate, owing to lack of referral bias [23]. In addition, the overall incidence rates of BSI reported from population-based studies were similar between the four countries where such data were directly provided (the USA, Denmark, Finland, and England), with only a 12% difference between the highest and lowest incidence rates of 189 and 166 per 100 000 person-years, respectively [4,[10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe

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Al-Hasan

2013

Clinical Microbiology and Infection

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376

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In this systematic review, we estimated the total number of episodes of bloodstream infection (BSI) and deaths from BSI per year in North America and Europe, using data from population-based settings. Then, we estimated the number of episodes and deaths from nosocomial BSI from population-based studies and nosocomial infection surveillance systems. We estimated 575 000-677 000 episodes of BSI per year in North America (536 000-628 000 in the USA and 40 000-49 000 in Canada) and 79 000-94 000 deaths (72 000-85 000 in the USA and 7000-9000 in Canada), using estimates from three population-based studies. We estimated over 1 200 000 episodes of BSI and 157 000 deaths per year in Europe, using estimates from one population-based study in each of the following countries: Denmark (9100 episodes and 1900 deaths), Finland (8700 episodes and 1100 deaths) and England (96 000 episodes and 12 000-19 000 deaths). There were substantial differences in estimates of nosocomial BSI between population-based and nosocomial infection surveillance data. BSI has a major impact on the morbidity and mortality of the general population, as it ranks among the top seven causes of death in all included countries in North America and Europe. However, it is difficult to obtain precise estimates of nosocomial BSI, owing to the limited number of studies. This review highlights the need for a greater focus on BSI research in order to reduce the overall burden of disease by improving the outcome of patients with BSI. It also emphasizes the role of infection control and prevention methods in reducing the burden of nosocomial BSI.

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Influence of referral bias on the clinical characteristics of patients with Gram-negative bloodstream infection

Cited by 36 publications

References 33 publications

A study of risk factors for bacteremia caused by urinary tract infections

A study of risk factors for bacteremia caused by urinary tract infections

Predictive scoring model of mortality in Gram-negative bloodstream infection

Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe

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