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Infection

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Derivation of a quick Pitt bacteremia score to predict mortality in patients with Gram-negative bloodstream infection

  • Sarah E. Battle
  • Matthew R. Augustine
  • Christopher M. Watson
  • P. Brandon Bookstaver
  • Joseph Kohn
  • William B. Owens
  • Larry M. Baddour
  • Majdi N. Al-HasanEmail author
Original Paper
  • 28 Downloads

Abstract

Purpose

This retrospective cohort study derived a “quick” version of the Pitt bacteremia score (qPitt) using binary variables in patients with Gram-negative bloodstream infections (BSI). The qPitt discrimination was then compared to quick sepsis-related organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS).

Methods

Hospitalized adults with Gram-negative BSI at Palmetto Health hospitals in Columbia, SC, USA from 2010 to 2013 were identified. Multivariate Cox proportional hazards regression was used to determine variables associated with 14-day mortality.

Results

Among 832 patients with Gram-negative BSI, median age was 65 years and 449 (54%) were women. After adjustments for age and Charleston comorbidity score, all five components of qPitt were independently associated with mortality: temperature < 36 °C [hazard ratio (HR) 3.02, 95% confidence interval (CI) 1.95–4.62], systolic blood pressure < 90 mmHg or vasopressor use (HR 2.40, 95% CI 1.37–4.13), respiratory rate ≥ 25/min or mechanical ventilation (HR 3.01, 95% CI 1.81–5.14), cardiac arrest (HR 5.35, 95% CI 2.81–9.43), and altered mental status (HR 3.99, 95% CI 2.44–6.80). The qPitt had higher discrimination to predict mortality [area under receiver operating characteristic curve (AUROC) 0.85] than both qSOFA (AUROC 0.77, p < 0.001) and SIRS (AUROC 0.63, p < 0.001). There was a significant difference in mortality between appropriate and inappropriate empirical antimicrobial therapy in patients with qPitt ≥ 2 (24% vs. 49%, p < 0.001), but not in those with qPitt < 2 (3% vs. 5%, p = 0.36).

Conclusions

The qPitt had good discrimination in predicting mortality following Gram-negative BSI and identifying opportunities for improved survival with appropriate empirical antimicrobial therapy.

Keywords

Bacteremia Sepsis Antibiotics Outcomes Survival 

Notes

Acknowledgements

The authors thank Prisma Health Antimicrobial Stewardship and Support Team in South Carolina, USA for their help in facilitating the conduct of this study. SEB, MRA and MNA have full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the analysis. The preliminary results of this study were presented in part at IDWeek annual meeting on October 7, 2017 in San Diego, CA, USA.

Funding

The study received internal funding from the Grant-in-Aid, Palmetto Health Richland Research and Education Foundation, Columbia, SC, USA. There were no other sources of funding for this study.

Compliance with ethical standards

Conflict of interest

MNA: Continuing medical education steering committee, Rockpointe Corporation. PBB: Advisory board member, CutisPharma; Speaker’s Bureau, Melinta Therapeutics; speaker and continuing medical education steering committee, Rockpointe Corporation. SEB, MRA, CMW, WO, JK, LMB: no conflicts.

Supplementary material

15010_2019_1277_MOESM1_ESM.tif (37 kb)
Supplementary material 1 Supplemental Figure 1: Calibration plot of qPitt model. The observed frequency of 14-day mortality plotted by deciles of predicted probability from the qPitt model (black dots). Perfect calibration is represented by the grey Y=X line (TIF 37 KB)
15010_2019_1277_MOESM2_ESM.tif (48 kb)
Supplementary material 2 Supplemental Figure 2: Receiver operating characteristic plot of qPitt model. Black line indicates receiver operating characteristic curve. Light color tangent line highlights the point in the curve that represents the best performance of the model. Area under receiver operating characteristic curve= 0.85 (TIF 48 KB)
15010_2019_1277_MOESM3_ESM.tif (45 kb)
Supplementary material 3 Supplemental Figure 3: Kaplan–Meier survival curves of patients with bloodstream infection and qPitt < 2 by appropriateness of empirical antimicrobial therapy (TIF 44 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sarah E. Battle
    • 1
  • Matthew R. Augustine
    • 2
  • Christopher M. Watson
    • 3
  • P. Brandon Bookstaver
    • 4
    • 5
  • Joseph Kohn
    • 5
  • William B. Owens
    • 1
    • 2
  • Larry M. Baddour
    • 6
  • Majdi N. Al-Hasan
    • 1
    • 2
    Email author
  1. 1.Department of MedicinePalmetto Health University of South Carolina Medical GroupColumbiaUSA
  2. 2.University of South Carolina School of MedicineColumbiaUSA
  3. 3.Department of Acute Care SurgeryPrisma Health Richland HospitalColumbiaUSA
  4. 4.Department of Clinical Pharmacy and Outcomes SciencesUniversity of South Carolina College of PharmacyColumbiaUSA
  5. 5.Department of PharmacyPrisma Health Richland HospitalColumbiaUSA
  6. 6.Department of Medicine, Division of Infectious DiseasesMayo ClinicRochesterUSA

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