Derivation of a quick Pitt bacteremia score to predict mortality in patients with Gram-negative bloodstream infection
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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).
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.
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).
The qPitt had good discrimination in predicting mortality following Gram-negative BSI and identifying opportunities for improved survival with appropriate empirical antimicrobial therapy.
KeywordsBacteremia Sepsis Antibiotics Outcomes Survival
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.
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.
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