Skip to main content

Advertisement

SpringerLink
Log in

Development and validation of a risk score for predicting positivity of blood cultures and mortality in patients with bacteremia and fungemia

  • Clinical Microbiology - Research Paper
  • Published:
Brazilian Journal of Microbiology Aims and scope Submit manuscript

This article has been updated

Abstract

Introduction

Bacteremia is a major cause of morbidity and mortality in hospitalized patients. Predictors of mortality are critical for the management and survival of hospitalized patients. The objective of this study was to determine the factors related to blood culture positivity and the risk factors for mortality in patients whose blood cultures were collected.

Methods

A prospective 2-cohort study (derivation with 784 patients and validation with 380 patients) based on the Pitt bacteremia score for all patients undergoing blood culture collection. The score was obtained from multivariate analysis. The Kaplan–Meier survival curve of the cohort derivation and the cohort validation groups was calculated, and the difference was assessed using a log-rank test. Mortality-related factors were older age, extended hospitalization, > 10% of immature cells in the leukogram, lower mean blood pressure, elevated heart rate, elevated WBC count, and elevated respiratory rate. These continuous variables were dichotomized according to their significance level, and a cut-off limit was created.

Results

The area under the ROC curve (AUC) was 0.789. The score was validated in a group of 380 patients who were prospectively evaluated.

Conclusion

Prolonged hospitalization, body temperature, and elevated heart rate were related to positive blood cultures. The Pitt score can be used to assess the risk of death; however it can be individualized according to the epidemiology of each hospital.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data are available on demand.

Change history

  • 16 January 2022

    ORCiD for Dr. Raquel Zanella Bertoldo was removed.

References

  1. Brooks D, Smith A, Young D, Fulton R, Booth MG (2016) Mortality in intensive care: the impact of bacteremia and the utility of systemic inflammatory response syndrome. Am J Infect Control 44(11):1291–1295

    Article  Google Scholar 

  2. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829

    Article  CAS  Google Scholar 

  3. Hilf M, Yu VL, Sharp J, Zuravleff JJ, Korvick JA, Muder RR (1989) Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. Am J Med 87(5):540–546

    Article  CAS  Google Scholar 

  4. Gutierrez-Gutierrez B, Salamanca E, de Cueto M, Hsueh PR, Viale P, Pano-Pardo JR et al (2016) A predictive model of mortality in patients with bloodstream infections due to carbapenemase-producing enterobacteriaceae. Mayo Clin Proc 91(10):1362–1371

    Article  Google Scholar 

  5. Rhee JY, Kwon KT, Ki HK, Shin SY, Jung DS, Chung DR et al (2009) Scoring systems for prediction of mortality in patients with intensive care unit-acquired sepsis: a comparison of the Pitt bacteremia score and the acute physiology and chronic health evaluation iI scoring systems. Shock 31(2):146–150

    Article  Google Scholar 

  6. Martinez RM, Wolk DM (2016) Bloodstream infections. Microbiol Spectr 4(4):1–34

  7. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596

    Article  Google Scholar 

  8. Chow JW, Fine MJ, Shlaes DM, Quinn JP, Hooper DC, Johnson MP et al (1991) Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 115(8):585–590

    Article  CAS  Google Scholar 

  9. Chow JW, Yu VL (1999) Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 11(1):7–12

    Article  CAS  Google Scholar 

  10. Forsblom E, Aittoniemi J, Ruotsalainen E, Helmijoki V, Huttunen R, Jylhava J et al (2014) High cell-free DNA predicts fatal outcome among Staphylococcus aureus bacteraemia patients with intensive care unit treatment. PLoS One. 9(2):e87741

    Article  Google Scholar 

  11. Henderson H, Luterbach CL, Cober E, Richter SS, Salata RA, Kalayjian RC et al (2020) The Pitt bacteremia score predicts mortality in non-bacteremic infections. Clin Infect Dis. 70(9):1826–1833

    Article  CAS  Google Scholar 

  12. Silva CS, Sena KX, Chiapetta AA, Queiroz MM, VIlar MC, Coutinho HM (2006) Incidência Bacteriana em Hemoculturas. NewsLab 77:12

    Google Scholar 

  13. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348(16):1546–1554

    Article  Google Scholar 

  14. Buetti N, Marschall J, Atkinson A, Kronenberg A, Swiss Centre for Antibiotic R (2016) National bloodstream infection surveillance in Switzerland 2008–2014: different patterns and trends for university and community hospitals. Infect Control Hosp Epidemiol 37(9):1060–7

    Article  Google Scholar 

  15. Wasihun AG, Wlekidan LN, Gebremariam SA, Dejene TA, Welderufael AL, Haile TD et al (2015) Bacteriological profile and antimicrobial susceptibility patterns of blood culture isolates among febrile patients in Mekelle Hospital. Northern Ethiopia Springerplus 4:314

    Article  Google Scholar 

  16. Haimi-Cohen Y, Shafinoori S, Tucci V, Rubin LG (2003) Use of incubation time to detection in BACTEC 9240 to distinguish coagulase-negative staphylococcal contamination from infection in pediatric blood cultures. Pediatr Infect Dis J 22(11):968–974

    Article  Google Scholar 

  17. Liberati A, D’Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E (2009) Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev. 4:CD000022

    Google Scholar 

  18. Lawrence KL, Kollef MH (2009) Antimicrobial stewardship in the intensive care unit: advances and obstacles. Am J Respir Crit Care Med 179(6):434–438

    Article  Google Scholar 

  19. Schermer CR, Sanchez DP, Qualls CR, Demarest GB, Albrecht RM, Fry DE (2002) Blood culturing practices in a trauma intensive care unit: does concurrent antibiotic use make a difference? J Trauma 52(3):463–468

    PubMed  Google Scholar 

  20. Previsdomini M, Gini M, Cerutti B, Dolina M, Perren A (2012) Predictors of positive blood cultures in critically ill patients: a retrospective evaluation. Croat Med J 53(1):30–39

    Article  CAS  Google Scholar 

  21. Sogaard M, Schonheyder HC, Riis A, Sorensen HT, Norgaard M (2008) Short-term mortality in relation to age and comorbidity in older adults with community-acquired bacteremia: a population-based cohort study. J Am Geriatr Soc 56(9):1593–1600

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Laboratorio de Doenças Infecciosas Emergentes, Pontifícia Universidade Católica Do Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná, 80215-901, Brazil

    Felipe Francisco Tuon, João Paulo Telles, Juliette Cieslinski & Victoria Stadler Tasca Ribeiro

  2. Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, 80730-150, Brazil

    Marilia Burdini Borghi & Raquel Zanella Bertoldo

Authors
  1. Felipe Francisco Tuon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. João Paulo Telles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juliette Cieslinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marilia Burdini Borghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raquel Zanella Bertoldo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Victoria Stadler Tasca Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FFT, conceptualization and final review; JPT, data analysis and draft manuscript; MBB, data evaluation and draft; RZB, data evaluation and draft; JC, database organization and analysis; VTR, draft review.

Corresponding author

Correspondence to Felipe Francisco Tuon.

Ethics declarations

Ethics approval

This study was approved by the local ethical committee.

Conflict of interest

The authors declare no competing interests.

Additional information

Responsible Editor: Afonso Luis Barth

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tuon, F.F., Telles, J.P., Cieslinski, J. et al. Development and validation of a risk score for predicting positivity of blood cultures and mortality in patients with bacteremia and fungemia. Braz J Microbiol 52, 1865–1871 (2021). https://doi.org/10.1007/s42770-021-00581-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42770-021-00581-5

Keywords

Search

Navigation