Predicting Bacteremia in Patients with Sepsis Syndrome

Abstract

The goal of this study was to develop and validate clinical prediction rules for bacteremia and subtypes of bacteremia in patients with sepsis syndrome. Thus, a prospective cohort study, including a stratified random sample of 1342 episodes of sepsis syndrome, was done in eight academic tertiary care hospitals. The derivation set included 881 episodes, and the validation set included 461. Main outcome measures were bacteremia caused by any organism, gram-negative rods, gram-positive cocci, and fungal bloodstream infection. The spread in probability between low- and high-risk groups in the derivation sets was from 14.5% to 60.6% for bacteremia of any type, from 9.8% to 32.8% for gram-positive bacteremia, from 5.3% to 41.9% for gram-negative bacteremia, and from 0.6% to 26.1% for fungemia. Because the model for gram-positive bacteremia performed poorly, a model predicting Staphylococcus aureus bacteremia was developed; it performed better, with a low- to high-risk spread of from 2.6% to 21.0%. The prediction models allow stratification of patients according to risk of bloodstream infections; their clinical utility remains to be demonstrated.

The epidemiology of the systemic inflammatory response

“…While nearly 41 % sepsis episodes occurred in non-ICU patients, only 24 % episodes of severe sepsis occurred in such patients, and 76 % were recorded in ICU patients [14].…”

“…In non-ICU patients, the prevalence of bacteraemia during severe sepsis was estimated at 48 %, compared to 38 % in ICU patients [13]. Likewise, Sands et al, found a prevalence of bacteraemia during severe sepsis of 50 % in non-ICU patients and of 26 % in ICU patients [8,14]. These data indicate that, although ICU patients are at much higher risk of severe sepsis than ward patients, bacteraemic severe sepsis is proportionally less often encountered in ICU than in non-ICU patients.…”

Soluble urokinase-type plasminogen activator receptor (suPAR) – a possible biomarker for bacteremia in sepsis / Forma solubilă a receptorului pentru activatorul de plasminogen de tip urokinază (suPAR) – un biomarker posibil pentru bacteriemie în sepsis

“…Although blood cultures remain the golden-standard in sepsis diagnosis, only 20-30% of patients with sepsis have positive blood cultures, and even then if positive, the result is obtained tardily (6,7). New techniques of culture-independent microbial nucleic acid amplification have significantly reduced the delay but they have the disadvantage of needing an elaborate technique that involves qualification and increased costs (8).…”

Circulating Inflammatory Mediators in Patients with Fever: Predicting Bloodstream Infection

“…The AUC for peak C3a was 0.69, that for peak IL-6 was 0.70, and that for peak sPLA 2 was 0.67 (for all, P Ͻ 0.001). about 0.70 and commonly lower (3)(4)(5)33). That clinical variables may only poorly relate to inflammatory mediators such as IL-6 has been suggested before (8,9,24,28,29).…”

“…The criteria of systemic inflammatory response syndrome (SIRS), which may predict microbial infection, are fever and elevated white blood cell (WBC) counts, while the SIRS criteria tachypnea and tachycardia may be nonspecific and too sensitive for microbial infection (2)(3)(4)(5)33). Hence, authors have searched, with varying success, for other objective predictors of the host response to microbial infection (2)(3)(4)(5)33). This may help to identify patients who may benefit most from immunomodulating therapies of sepsis, trials that have failed so far in heterogeneous patient populations with sepsis (1).…”