Prediction of mortality in Staphylococcus aureus bloodstream infection using quick Pitt bacteremia score

Battle, Sarah; Shuping, Matthew; Withers, Sarah; Justo, Julie Ann; Bookstaver, P. Brandon; Al-Hasan, Majdi N.

doi:10.1016/j.jinf.2021.12.002

Cited by 16 publications

(21 citation statements)

References 24 publications

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“…With up to 20% mortality (Bai, Lo et al, Battle, Shuping et al 2021) and increasing incidence (Imam, Tempone et al 2019), Staphylococcus aureus bloodstream infections are a key challenge to human health (Tong, Davis et al 2015). The clinical determinants of Staphylococcus aureus bacteraemia (SAB) outcomes have been described extensively, in particular mortality has been the subject of numerous studies (reviewed here (van Hal, Jensen et al 2012)).…”

Section: Introductionmentioning

confidence: 99%

A statistical genomics framework to trace bacterial genomic predictors of clinical outcomes in Staphylococcus aureus bacteraemia

Giulieri

Guérillot

Holmes

et al. 2022

Preprint

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Outcomes for patients with severe bacterial infections are determined by the interplay between host, pathogen, and treatments. Most notably, patient age and antibiotic resistance contributes significantly to poor outcomes. While human genomics studies have provided insights into the host genetic factors impacting outcomes of Staphylococcus aureus infections, comparatively little is known about S. aureus genotypes and disease severity. Building on the idea that bacterial pathoadaptation is a key driver of clinical outcomes, we develop a new genome-wide association study (GWAS) framework to identify adaptive bacterial mutations associated with clinical treatment failure and mortality in three large and independent S. aureus bacteraemia cohorts, comprising 1358 episodes. We discovered S. aureus loci with previously undescribed convergent mutations linked to both poorer infection outcomes and reduced susceptibility to vancomycin. Our research highlights the potential of vancomycin-selected mutations and vancomycin MIC as key explanatory variables to predict SAB severity. The contribution of bacterial variation was much lower for clinical outcomes (heritability < 5%), however, GWAS allowed us to identify additional, MIC-independent candidate pathogenesis loci. Using supervised machine-learning, we were able to quantify the predictive potential of these adaptive S. aureus signatures, along with host determinants of bacteraemia outcomes. The statistical genomics framework we have developed is a powerful means to capture adaptive mutations and find bacterial factors that influence and predict severe infections. Our findings underscore the importance of systematically collected, rich clinical and microbiological data to understand bacterial mechanisms promoting treatment failure.

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Section: Introductionmentioning

confidence: 99%

A statistical genomics framework to trace bacterial genomic predictors of clinical outcomes in Staphylococcus aureus bacteraemia

Giulieri

Guérillot

Holmes

et al. 2022

Preprint

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“…Yet the qpitt contains relatively few indicators, there is some controversy about the accuracy of severity assessment and prognosis judgment. 18–20 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.…”

Section: Discussionmentioning

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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“…Implementing the qSOFA score retained, but altered, one SIRS criterion. Raising the RR from > 20 to ≥ 22 is a small but important step in the right direction since mild tachypnea represents a physiologic response to infection, while other studies demonstrated that a RR ≥ 25 better defined respiratory distress as a sign of dysregulation and was independently associated with high mortality in patients with BSI [10,17].…”

Section: Limitations Of the Sofa/qsofa Scoresmentioning

confidence: 99%

“…Critically ill patients with PBS ≥ 4 have much higher mortality than those with PBS < 2. For simplification, a qPitt was derived and validated to predict mortality in patients with BSI [10,17]. The qPitt consists of five clinical variables each assigned one point (hypothermia, hypotension, respiratory failure, cardiac arrest, and altered mental status) [10,17,23].…”

Section: Does the Sepsis-3 Definition Represent A Novel Or Revolution...mentioning

confidence: 99%

The progression of sepsis from physiologic systemic inflammatory response to immune dysregulation due to life-threatening infections

Daering

Al-Hasan

2022

Explor Immunol

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Sepsis was defined in 1991 by the systemic inflammatory response syndrome (SIRS) criteria which consisted mostly of physiologic responses to infection or inflammation (fever, tachycardia, tachypnea, and leukocytosis). These criteria were initially proposed to identify patients with gram-negative bloodstream infection (BSI). However, most patients with BSI are not critically ill at initial presentation using objective clinical scores for acute severity of illness, such as the Pitt bacteremia score (PBS). Lack of specificity and low positive predictive value (PPV) are other pitfalls of the SIRS criteria. Moreover, the implementation of sepsis interventions based on this outdated definition failed to improve patients’ outcomes and in some settings was associated with increased use of broad-spectrum antibiotics and Clostridioides difficile (C. difficile) infection. In 2016, sepsis was redefined as a dysregulatory host response to life-threatening infections using quick sequential organ failure assessment (qSOFA) score. The presence of two of three bedside clinical variables (hypotension, respiratory distress, and altered mental status) that have consistently predicted mortality in patients with infections now constitutes sepsis. The scientific debate continues in the medical literature regarding the performance of the new criteria. Some medical professionals and quality organizations consider these changes to the sepsis definition too revolutionary and are resistant to altering existing medical practice. This narrative review presents infection as a continuum from localized to systemic infection (pre-sepsis) with the potential progression into sepsis and septic shock if appropriate antibiotic therapy and source control are delayed. The review assesses host and microbial factors that may influence the rate of progression through the sepsis cascade and proposes diagnostic considerations and management decisions at each step of the way. It emphasizes the need to utilize precision medicine concepts in selecting empirical antibiotic therapy based on patient-specific risk factors for infections due to resistant bacteria and potential benefits from appropriate therapy across the sepsis spectrum.

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Prediction of mortality in Staphylococcus aureus bloodstream infection using quick Pitt bacteremia score

Cited by 16 publications

References 24 publications

A statistical genomics framework to trace bacterial genomic predictors of clinical outcomes in Staphylococcus aureus bacteraemia

A statistical genomics framework to trace bacterial genomic predictors of clinical outcomes in Staphylococcus aureus bacteraemia

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

The progression of sepsis from physiologic systemic inflammatory response to immune dysregulation due to life-threatening infections

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