Infection Probability Score, APACHE II and KARNOFSKY scoring systems as predictors of bloodstream infection onset in hematology-oncology patients

Eleni Apostolopoulou,Konstantinos Terzis,Vasilios Raftopoulos,Ioannis Elefsiniotis

doi:10.1186/1471-2334-10-135

Abstract

BackgroundBloodstream Infections (BSIs) in neutropenic patients often cause considerable morbidity and mortality. Therefore, the surveillance and early identification of patients at high risk for developing BSIs might be useful for the development of preventive measures. The aim of the current study was to assess the predictive power of three scoring systems: Infection Probability Score (IPS), APACHE II and KARNOFSKY score for the onset of Bloodstream Infections in hematology-oncology patients.MethodsA total of 102 patients who were hospitalized for more than 48 hours in a hematology-oncology department in Athens, Greece between April 1st and October 31st 2007 were included in the study. Data were collected by using an anonymous standardized recording form. Source materials included medical records, temperature charts, information from nursing and medical staff, and results on microbiological testing. Patients were followed daily until hospital discharge or death.ResultsAmong the 102 patients, Bloodstream Infections occurred in 17 (16.6%) patients. The incidence density of Bloodstream Infections was 7.74 per 1,000 patient-days or 21.99 per 1,000 patient-days at risk. The patients who developed a Bloodstream Infection were mainly females (p = 0.004), with twofold time mean length of hospital stay (p < 0.001), with fourfold time mean length of neutropenia (p < 0.001), with neutropenia < 500 (p < 0.001), suffered mainly from acute myeloid leukemia (p < 0.001), had been exposed to antibiotics (p = 0.045) and chemotherapy (p = 0.023), had a surgery (p = 0.048) and a Hickman catheter (p = 0.025) as compared to the patients without Bloodstream Infection. The best cut-off value of IPS for the prediction of a Bloodstream Infection was 10 with a sensitivity of 75% and specificity of 70.9%ConclusionBetween the three different prognostic scoring systems, Infection Probability Score had the best sensitivity in predicting Bloodstream Infections.

Highlights

Bloodstream Infections (BSIs) in neutropenic patients often cause considerable morbidity and mortality
Patients with hematologic malignancies such as acute leukemia, malignant lymphoma, and multiple myeloma are at increased risk for healthcare-associated bloodstream infections because of the intensive cytotoxic
The objective of this study was to assess the predictive power of three systems: Infection Probability Score (IPS), APACHE II and Karnofsky score for the onset of BSIs in hematology/oncology patients, which will provide a basis to design more effective guidelines for the prevention and treatment of these infections

Summary

Introduction

Bloodstream Infections (BSIs) in neutropenic patients often cause considerable morbidity and mortality. Laboratory-based strategies for the surveillance of bloodstream infections in the hematology department should be reported periodically, and used for longitudinal assessment [6]. Such data can inform decisions about screening, prophylaxis and empirical therapy. Surveillance may be justified in case of hospital outbreaks or periods of increasing endemicity, to facilitate the isolation and barrier precautions for the patients who are colonized or infected with multi-resistant organisms. For clusters or outbreaks of hospital infections, appropriate investigation, including environmental sampling, clinical screening and risk factor analysis may be required [11]

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