Predictors Of Bloodstream Infection Research Articles

Fever at Time of Leukemia Diagnosis in Children: Predictor of Bloodstream Infection or Catheter Removal?

PurposeTo assess the incidence of fever at diagnosis in children with leukemia and determine if fever at diagnosis is a predictor of bloodstream infection (BSI) or central venous access device (CVAD) removal for infection either within the first 30 days or between 30 and 90 days after CVAD insertion. Materials and MethodsOne hundred fifty-one patients with acute leukemia (July 1, 2018, to December 31, 2020) who underwent a CVAD insertion within 2 weeks of diagnosis were included. Patient data included demographic characteristics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1,000 catheter days, and need for catheter removal after CVAD insertion within 30 days and between 30 and 90 days. ResultsPatients with fever at diagnosis had a significantly higher incidence of BSI within the first 30 days after CVAD insertion (17/23) than that among patients without fever (6/23) (P = .046) at diagnosis. No statistically significant difference was observed in the incidence of BSI between 30 and 90 days after CVAD insertion between patients with fever (5/11) and those without fever at diagnosis (6/11) (P = .519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients required CVAD removal; 7/9 had fever and 2/9 had no fever) (P = .181) or between 30 and 90 days (4 patients required CVAD removal; 1/4 had fever and 3/4 had no fever at diagnosis) (P = .343) after insertion. ConclusionsFever at diagnosis in patients with leukemia is not a predictor of CVAD removal for infection.

Epidemiology of Nontyphoidal Salmonella Bloodstream Infections in Children.

Nontyphoidal Salmonella (NTS) infections are the most common culture-confirmed foodborne illness in the United States. Although extremes of age and chronic or immunosuppressing conditions are known risk factors for NTS bloodstream infection (BSI), further predictors of BSI and BSI with focal infection in children remain poorly understood. This was a retrospective review of NTS-positive blood cultures collected from 1999 to 2018 and stool studies collected from 2009 to 2018 in children. Incidence rates and risk factors for NTS BSI with and without focal infection were determined. Incidence rates of NTS BSI have not decreased over the last 20 years. There were 211 cases of NTS BSI with an incidence rate of 1.4 per 100 000 children per year. Twenty-one (10%) had underlying comorbidities. S. heidelberg was the most common serotype occurring in 45 (21%) cases. Compared with children with uncomplicated NTS BSI, children with NTS BSI with focal infection were more likely to have an underlying comorbidity, less diarrhea, and higher absolute neutrophil count. On multivariable analysis, the only difference in having NTS BSI in children with NTS gastroenteritis who had blood cultures obtained was a longer duration of fever (4.4 vs 2.5 days), less bloody diarrhea, and S. heidelberg isolated from stool. Laboratory studies, group of NTS, and other symptoms were not significant. Clinicians should remain vigilant for NTS BSI in children with prolonged fevers. S. heidelberg is the most common cause of NTS BSI in children and a predictor of BSI in children with NTS gastroenteritis.

Is the SIRS Criteria a Good Predictor of Blood stream Infection in Cirrhosis? A Single-Center Retrospective Analysis

IntroductionCirrhosis-associated immune dysfunction (CAID) is a chronic vasodilatory state with hyperdynamic circulation and alterations in thermoregulation that may make patients more susceptible to and mask underlying infection. This study aims to determine whether SIRS criteria are an accurate tool for predicting bloodstream infection (BSI) in cirrhosis. MethodsIn our retrospective chart review, study population included patients with cirrhosis that were 18 years or older. For all study patients, model for end-stage liver disease (MELD) scores and values for each SIRS variable at the time of admission and blood culture data were recorded. Univariable and multivariable logistic regression analysis was performed to identify any associations between dichotomized SIRS variables that fulfill SIRS positivity and BSI. ResultsSignificantly more patients without BSI met positivity criteria for WBC counts (30% vs 13% p < .001). In the analysis of the SIRS variables as continuous variables in prediction of BSI, the AUC curves generated were all unsatisfactory with the temperature (36-38°C) and WBC count (4 × 103 to 12 × 103 mcL) at the time of admission having the highest areas under the ROC curve (0.52 and 0.55, respectively). Looking at the SIRS variables dichotomized (according to whether fulfilling SIRS criteria or not) in univariable logistic regression, only WBC counts meeting SIRS criteria were significantly associated with BSI OR 0.37 (0.18-0.77); p = .008, but this was an inverse association. This association was true even in the multivariable model OR 0.38 (0.18-0.80); p = .01. ConclusionOur study shows that SIRS criteria are a poor predictor of BSI among patients with cirrhosis.

710 Specific Patterns of Vital Sign Fluctuations Predict Bloodstream Infection in Pediatric Burn Patients

IntroductionEarly recognition of the clinical signs of bloodstream infection in pediatric burn patients is key to improving survival rates in the burn unit. The objective of this study was to propose a simple scoring criteria that used readily available temperature, heart rate (HR) and mean arterial pressure (MAP) data to accurately predict bloodstream infection in pediatric burn patients.MethodsA retrospective chart review included 100 patients admitted to the pediatric burn unit for >20% total body surface area (TBSA) burn injuries. Each patient had multiple blood culture tests, and each test was treated as a separate and independent “infection event” for analysis. The time at each blood culture draw was time 0 for that event, and temperature, HR and MAP data was collected for 24 hours after the blood culture was drawn. “Infection events” included in this study had at least six complete sets of temperature, HR and MAP data entries. Median temperature, HR and MAP, as well as mean fever spikes, HR spikes and MAP dips, were compared between infection group (positive blood cultures) and control group (negative blood cultures). These vital sign fluctuations were evaluated individually and as a combination of all three as timely predictors of bloodstream infection. In addition, we tested the prediction of Gram-negative bacteria versus Gram-positive or fungi present in blood cultures.ResultsPatients in the infection group had significantly higher median temperatures (p< 0.001), mean fever spikes (p< 0.001) and mean HR spikes (p< 0.001), compared to the control group. Using the combination scoring criteria to predict bloodstream infection, the strongest predictive values in the 24-hour timeframe had high sensitivity (93%) and specificity (81%). The predictive test metric based on vital sign spikes predicted Gram-negative bacteria, but with limited sensitivity (57%) and specificity (44%).ConclusionsThis study found that using a combination scoring criteria of fever spikes, HR spikes and MAP dips predicted bloodstream infection in pediatric patients with burn injuries with 87% accuracy, which may justify its use in resource-poor environments, or in cases where practical supporting evidence is needed for preemptive antibiotic treatment before culture results are available.

Specific patterns of vital sign fluctuations predict infection and enable sepsis diagnosis in pediatric burn patients.

Early recognition of the clinical signs of bloodstream infection in pediatric burn patients is key to improving survival rates in the burn unit. The objective of this study was to propose a simple scoring criteria that used readily available temperature, heart rate (HR) and mean arterial pressure (MAP) data to accurately predict bloodstream infection in pediatric burn patients. A retrospective chart review included 100 patients admitted to the pediatric burn unit for >20% total body surface area (TBSA) burn injuries. Each patient had multiple blood culture tests, and each test was treated as a separate and independent "infection event" for analysis. The time at each blood culture draw was time 0 for that event, and temperature, HR and MAP data was collected for 24 hours after the blood culture was drawn. "Infection events" included in this study had at least six complete sets of temperature, HR and MAP data entries. Median temperature, HR and MAP, as well as mean fever spikes, HR spikes and MAP dips, were compared between infection group (positive blood cultures) and control group (negative blood cultures). These vital sign fluctuations were evaluated individually and as a combination of all three as timely predictors of bloodstream infection. In addition, we tested the prediction of Gram-negative bacteria versus Gram-positive or fungi present in blood cultures. Patients in the infection group had significantly higher median temperatures (p<0.001), mean fever spikes (p<0.001) and mean HR spikes (p<0.001), compared to the control group. Using the combination scoring criteria to predict bloodstream infection, the strongest predictive values in the 24-hour timeframe had high sensitivity (93%) and specificity (81%). The predictive test metric based on vital sign spikes predicted Gram-negative bacteria, but with limited sensitivity (57%) and specificity (44%). A simple scoring criteria using a combination of fever spikes, HR spikes and MAP dips predicted bloodstream infection in pediatric burn patients, and can be feasibly implemented in routine clinical care. There is also potential to use the predictive metric to detect a few select organisms based on vital signs, however further work is necessary to enhance accuracy to levels that would allow consideration for clinical use.

PLB-003 - Prediction of bloodstream infection in patients with hematopoietic stem cell transplantation by plasma microbial cell-free DNA sequencing

PLB-003 - Prediction of bloodstream infection in patients with hematopoietic stem cell transplantation by plasma microbial cell-free DNA sequencing

Early prediction of blood stream infection in a prospectively collected cohort

BackgroundBlood stream infection (BSI) and sepsis are serious clinical conditions and identification of the disease-causing pathogen is important for patient management. The RISE (Rapid Identification of SEpsis) study was carried out to collect a cohort allowing high-quality studies on different aspects of BSI and sepsis. The aim of this study was to identify patients at high risk for BSI who might benefit most from new, faster, etiological testing using neutrophil to lymphocyte count ratio (NLCR) and Shapiro score.MethodsAdult patients (≥ 18 years) presenting at the emergency department (ED) with suspected BSI were prospectively included between 2014 and 2016 at Örebro University Hospital. Besides extra blood sampling, all study patients were treated according to ED routines. Electronic patient charts were retrospectively reviewed. A modified Shapiro score (MSS) and NLCR were extracted and compiled. Continuous score variables were analysed with area under receiver operator characteristics curves (AUC) to evaluate the ability of BSI prediction.ResultsThe final cohort consisted of 484 patients where 84 (17%) had positive blood culture judged clinically significant. At optimal cut-offs, MSS (≥3 points) and NLCR (> 12) showed equal ability to predict BSI in the whole cohort (AUC 0.71/0.74; sensitivity 69%/67%; specificity 64%/68% respectively) and in a subgroup of 155 patients fulfilling Sepsis-3 criteria (AUC 0.71/0.66; sensitivity 81%/65%; specificity 46%/57% respectively). In BSI cases only predicted by NLCR> 12 the abundance of Gram-negative to Gram-positive pathogens (n = 13 to n = 4) differed significantly from those only predicted by MSS ≥3 p (n = 7 to n = 12 respectively) (p < 0.05).ConclusionsMSS and NLCR predicted BSI in the RISE cohort with similar cut-offs as shown in previous studies. Combining the MSS and NLCR did not increase the predictive performance. Differences in BSI prediction between MSS and NLCR regarding etiology need further evaluation.

Clinical factors associated with bloodstream infection at the emergency department

BackgroundBloodstream infection (BSI) is a common urgent condition at the emergency department (ED). However, current guidelines for diagnosis do not specify the juncture at which blood cultures should be taken. The decision whether or not to obtain hemoculture is based solely upon clinical judgment and potential outcomes of inappropriately ordered cultures. This study aimed to find clinical factors present on ED arrival that are predictive of bloodstream infection.MethodsThis study was conducted retrospectively at the ED of a single tertiary care hospital in Thailand. We included adult patients with suspected infection based on blood culture who were treated with intravenous antibiotics during their ED visit. Independent positive predictors for positive blood culture were calculated by logistic regression analysis.ResultsA total of 169,578 patients visited the ED during the study period, 12,556 (7.40%) of whom were suspected of infection. Of those, 8177 met the study criteria and were categorized according to blood culture results (741 positive; 9.06%). Six clinical factors, including age over 55 years, moderate to severe CKD, solid organ tumor, liver disease, history of chills, and body temperature of over 38.3 °C, were associated with positive blood culture.ConclusionsClinical factors at ED arrival can be used as predictors of bloodstream infection.

Bloodstream Infection in Moderately Severe and Severe Acute Pancreatitis: Microbiological Features and a Prediction Model

Background: Prediction of BSI would contribute to the management of MSAP and SAP. This study aimed to investigate pathogens distribution of bloodstream infection (BSI) in moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) patients and develop a prediction model for BSI development. Methods: MSAP and SAP patients admit to West China Hospital from January 2012 to December 2018 were collected. Include patients were divided into BSI group and non-bloodstream infection (NBSI) group. Isolated pathogens and antibiotic resistance were recorded. The least absolute shrinkage and selection operator (LASSO) regression was used to select the risk factors for BSI. Logistic regression was used to develop a nomogram. Random forest was used to validate the stable ability of prediction factors. The areas under receiver operating characteristic (AUC) and calibration curves were plotted to evaluate the prediction performance. Findings: 399 BSI patients and 1155 NBSI patients were enrolled in this study. Of the 408 isolated pathogens, 226 (55.39%) were gram-negative bacteria. Seven predictors (intensive care unit stay, cardiovascular failure, percentage of neutrophil, percentage of lymphocyte, triglyceride, low-density lipoprotein, and albumin) were identified for BSI. The nomogram prediction model has 0.913 and 0.888 AUCs in training and validation sets. The calibration curves show the nomogram has a good consistency. Interpretation: Gram-negative bacteria were the major BSI pathogens. A new nomogram with a high predictive value based on selected factors was built. It can be conveniently used to predict BSI development and help clinicians rationally use antibiotics in MSAP and SAP patients. Funding: This work was supported by the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYJC18027); Sichuan Science and Technology Program (2020YFS0263); and Sichuan Science and Technology Program (2021YFS0234). Declaration of Interest: The authors declare no potential conflicts of interest. Ethical Approval: The Ethics Committee of West China Hospital approved the study (No. 2021-675)

Elevated bands as a predictor of bloodstream infection and in-hospital mortality.

Although >10% bands on a CBC has been a part of the definition for sepsis, scant data exists regarding the clinical significance of lower percentages of bands. Our aim was to determine whether any associations exist between percentage of bands on an initial CBC and likelihood of a bloodstream infection and in-hospital mortality. We performed a retrospective study of emergency department adults from January 1, 2016 to September 1, 2019 who had a CBC with manual differential and blood cultures obtained during their initial evaluation. Band percentages were grouped into zero (0% bands), minimal (1-2% bands), mild (3-4% bands), moderate (5-10% bands) and high (>10% bands). The primary outcomes were bloodstream infections and in-hospital mortality. Increasing rates of bloodstream infections were observed as bands went from zero (95% CI: 9.3%-10.5%) to minimal (17.5%-19.1%, p<0.0001), minimal to mild (19.2%-22.0%, p=0.0039), mild to moderate (23.5%-26.7%, p<0.0001), and moderate to high (33.0%-37.4%, p<0.0001). Similar observations were seen when comparing mortality. The most common bloodstream infections were due to Gram-negative bacilli. Elevated bands on an initial CBC were correlated with the likelihood of a concurrent bloodstream infection and in-hospital mortality, even at levels below 10%. Our results suggest that clinical suspicion for a bloodstream infection due to Gram-negative bacilli should rise if bands are elevated on an initial CBC. Therefore, clinicians should consider obtaining blood cultures if bands are elevated on an initial CBC.

Utility of procalcitonin as a predictor of bloodstream infections and supportive modality requirements in critically ill cancer patients

BackgroundWe evaluated the diagnostic utility of procalcitonin (PCT) in predicting bacterial bloodstream infections (BSI) in critically ill cancer patients with and without neutropenia. We also investigated the role of PCT as a prognostic marker of supportive modalities (vasopressors, invasive mechanical ventilation, and renal replacement therapy (RRT)) in the intensive care unit (ICU). MethodsWe retrospectively analyzed 2200 PCT and blood cultures from adult cancer patients with suspected sepsis. Primary outcome was BSI, defined by positive blood culture, collected within 72 h of PCT collection. ResultsMedian PCT values were higher in encounters with BSI (3.2 vs 0.5 ng/ml, p < 0.001). The area under the ROC curve (AUC) was 0.726 (95%CI 0.698, 0.754). PCT > 2.0 ng/ml was significantly associated with greater likelihood of BSI and this effect was significantly stronger for neutropenic (OR 9.09, 95%CI: 4.39, 18.79) compared with non-neutropenic patients (OR 4.00 (95% CI: 3.13, 5.10), interaction p = 0.036). PCT > 2.0 was associated with vasopressor requirement on ICU admission (OR 1.82 (95% CI 1.31, 2.53), p < 0.001) and RRT (OR 2.20 (95% CI 1.24, 3.91), p = 0.007). ConclusionsProcalcitonin is a fair discriminator of BSI in critically ill cancer patients with and without neutropenia and a PCT > 2.0 ng/ml was significantly more likely to require vasopressors and RRT in the ICU.

Prevalence of Bloodstream Infections in Children With Short-Bowel Syndrome With a Central Line Presenting to Emergency Department With Fever.

Children with short-bowel syndrome (SBS) have significant morbidity and mortality from bloodstream infections (BSIs). We studied the prevalence of BSI in children with SBS and identified possible predictors of BSI. This retrospective cohort study included patients with SBS who presented to Holtz Children's Hospital from April 1, 2009, to June 30, 2014, with fever or reported fever. Data including vital signs, white blood cell (WBC) count, C-reactive protein (CRP) levels, and blood and urine cultures were reviewed. We calculated the prevalence of BSI and its confidence level. We also assessed the odds of BSI with increases in WBC and CRP values. A total of 246 encounters were evaluated. The adjusted calculated prevalence rate for BSI in children with SBS and fever was 55% (95% CI, 42.3%-65.4%). There were 114 gram-negative infections (72.6%), 46 gram-positive infections (29.3%), and 17 fungal infections (10.8%). Using the regression model, each additional 10 units above 20 mg/L CRP increased the odds of BSI by 26%. There was no association between WBC count and the presence of BSI. Children with fever and SBS are at high risk for BSI with gram-positive and gram-negative organisms as well as fungus. WBC count at presentation is a poor predictor of BSI. Though elevated CRP increased the odds of BSI, its low negative predictive value made it a poor predictor of BSI in these patients. Children with SBS and fever should be treated urgently with broad-spectrum antibiotics.

Prediction of bloodstream infection caused by extended-spectrum β-lactamase-producing Enterobacterales in patients with suspected community-onset sepsis

In severe infections, time to appropriate therapy is decisive for survival. Patients with bloodstream infection caused by extended-spectrum β-lactamase-producing Enterobacterales (EPE-BSI) often receive inadequate empirical treatment. This study aimed to identify risk factors, to evaluate a previously suggested risk score and to suggest a new score for facilitating empirical treatment choice. Predictors for EPE-BSI were assessed through a retrospective case-control design. The diagnostic performance of the two scores was evaluated. Included patients had blood cultures sampled at four EDs in Stockholm (2012-2015), were admitted, and received antibiotics with activity against Gram-negative bacilli. A total of 277 EPE-BSI cases and 400 controls were included. The strongest predictor of EPE-BSI was prior EPE-positive culture (cases 33% vs. controls 3%; multivariate (MV) OR = 19.1). Recent EPE-positivity within ≤3 months had a univariate OR of 32.8. Other major predictors were recent prostate biopsy (14% vs. 1%; MV OR = 22.2) and healthcare abroad (6% vs. 2%; MV OR = 3.9). Several previously suggested risk factors were not associated with EPE-BSI. The previously developed Utrecht score had a sensitivity of 54% and a specificity of 77%. The Stockholm score suggested herein (prior EPE-positive culture/prostate biopsy/healthcare abroad) showed comparable sensitivity (50%) but better specificity (96%). Prediction in patients lacking major predictors was difficult and caused high false-positive rates, which would cause unnecessary overtreatment. Prior EPE-positive culture, especially recently sampled, prostate biopsy and healthcare abroad were the strongest risk factors for community-onset EPE-BSI in Stockholm. Local data are needed when evaluating risk-scoring models before implementation.

Systemic Inflammatory Response Syndrome Is Not an Indicator of Bacteremia in Hemodialysis Patients With Native Accesses: A Multicenter Study.

Bloodstream infection (BSI) in hemodialysis (HD) patients is often difficult to diagnose. Systemic inflammatory response syndrome (SIRS) is a sensitive predictor of BSI in the general population. We aimed to assess the usefulness of SIRS in predicting BSI in HD patients. We designed a multicenter retrospective observational study of adult (age > 18 years) HD patients who underwent two sets of blood cultures for suspected BSI at first hospital visit from August 2011 to July 2012. Clinical, biological, and microbial data were evaluated to evaluate SIRS as a predictor of BSI upon initial presentation to the hospital. Data were obtained from 279 HD patients. Vascular access other than arteriovenous fistula and subcutaneously fixed superficial artery, and those administered antimicrobial drugs before visit were excluded; thus, a total of 202 patients were finally enrolled. Mean patient age was 71 years, 67.3% were male, 49.3% had diabetes, 28.2% had indwelling hardware, and 18.3% patients had BSI. Endocarditis and vertebral osteomyelitis were common infection sites, and Staphylococcus aureus was the most common pathogen. Of those with SIRS, 25.3% had BSI and 74.7% did not (odds ratio for SIRS, 2.10; 95% confidence interval, 0.90-4.91; p = 0.11). Thus, SIRS had a low sensitivity for predicting BSI in HD patients (sensitivity, 71.9%; specificity, 45.2%; positive likelihood ratio, 1.31; negative likelihood ratio, 0.62). Systemic inflammatory response syndrome has low sensitivity in identifying BSI in HD patients. A low threshold for drawing blood cultures and initiating antibiotic treatment should be considered for HD patients.

Risk factors for bloodstream infection caused by extended-spectrum β-lactamase–producing Escherichia coli and Klebsiella pneumoniae: A focus on antimicrobials including cefepime

Extended-spectrum β-lactamase (ESBL)-producing pathogens represent increasing challenges to physicians because of rising prevalence, high mortality, and challenging treatment. Identifying high risks and early appropriate therapy is critical to favorable outcomes. This is a 5-year retrospective case-case-control study performed at the Detroit Medical Center on adult patients with bloodstream infection (BSI) caused by ESBL-producing and non-ESBL-producing Escherichia coli or Klebsiella pneumoniae, each compared with uninfected controls. Data were collected from December 2004-August 2009. Multivariate analysis was performed using logistic regression. Participants included 103 patients with BSI caused by ESBL-producing pathogens and 79 patients with BSI caused by pathogens that did not produce ESBLs. The mean age of patients in the ESBL group was 67 years; of the patients, 51% were men, 77% were black, and 38% (n= 39) died in hospital. The mean age of patients in the non-ESBL group was 58 years; of the patients, 51% were men, 92% were black, and 22% (n= 17) died in hospital. On multivariate analysis, predictors of BSI caused by ESBL-producing pathogens included central venous catheter (odds ratio [OR], 29.4; 95% confidence interval [CI], 3.0-288.3), prior β-lactam-/β-lactamase-inhibitor therapy (OR, 28.1; 95% CI, 1.99-396.5), and prior cefepime therapy (OR, 22.7; 95% CI, 2.7-192.4). The only risk factor for BSI caused by non-ESBL-producing pathogens was urinary catheter insertion (OR, 18.2; 95% CI, 3.3-100.3). Prior antimicrobial therapy, particularly with β-lactam, was the strongest unique risk factor for BSI caused by ESBL-producing E coli or K pneumoniae.

Bloodstream infections among carriers of carbapenem-resistant Klebsiella pneumoniae: etiology, incidence and predictors

Carriers of carbapenem-resistant Klebsiella pneumoniae (CRKP) are increasingly recognised through active surveillance in much of the world. We studied incidence, aetiology and predictors of bloodstream infections (BSI) among such carriers. Via a retrospective cohort study conducted in a tertiary care teaching hospital, we examined occurrence of BSI within 45 days of CRKP carrier detection. Three nested case-control studies were conducted to analyse parameters associated with all-cause (ALL), Gram-negative rod (GNR) and CRKP BSI. Cases and controls were compared with respect to demographics, clinical parameters and recent receipt of antibiotics. A total of 431 patients were identified as CRKP carriers (28% by clinical culture, 72% by rectal surveillance), mean age was 75.2 years. Twenty percent of the patients (n = 85) developed BSI, of them 80% (n = 68) with GNR. Of 83 GNR isolates, 58 (70%) were Enterobacteriaceae, of which 19 were CRKP and 20 were extended-spectrum β-lactamase (ESBL) producers (23% and 24% of total GNR, respectively); 29% of the GNR isolates were nonfermenters (14.5% Pseudomonas aeruginosa, 14.5% Acinetobacter baumannii). Mechanical ventilation predicted ALL BSI (p = 0.04), whereas Clostridium difficile–associated diarrhoea predicted GNR BSI (p = 0.04). Receipt of broad-spectrum antibiotics (piperacillin-tazobactam, amikacin, imipenem) was significantly associated with ALL BSI or GNR BSI. No exposure independently predicted CRKP BSI. We conclude that patients detected as CRKP carriers are at high risk for BSI within 45 days of detection, primarily with multidrug-resistant GNR. Lack of predictive factors differentiating between pathogens and associated high mortality raises once more the dilemma regarding the appropriate empiric therapy for CRKP carriers who develop severe sepsis.

Predicting Bloodstream Infection via Systemic Inflammatory Response Syndrome or Biochemistry

BackgroundThe yield of blood cultures is approximately 10%. This could be caused by inaccurate prediction of patients with bloodstream infection (BSI). ObjectivesTo evaluate the usability of systemic inflammatory response syndrome (SIRS) or biochemical analyses as predictors for positive blood culture. MethodsWe conducted a prospective cohort study at a Danish regional hospital from February 1 to April 30, 2010. All adult patients were included on the first time blood cultures were sampled during admission. Data were obtained from medical records, databases on microbiology, biochemistry, and antibiotic treatment. Data included time of admission, date and result of blood culture, results of biochemical analyses, and clinical measurements on the day of blood culture. Prediction of BSI was analyzed according to both individual parameters and parameters combined in different sepsis score groups. Associations were calculated using multiple logistic regression. ResultsPatients with BSI (68 patients) were compared to patients without BSI (828 patients). Respiratory rate, body temperature, and C-reactive protein were strongest associated with BSI, with adjusted odds ratio (OR) 5.42, 95% confidence interval (CI) 1.13–25.9; OR 2.55, 95% CI 1.34–4.87; and OR 6.06, 95% CI 0.82–44.6, respectively. SIRS was associated with BSI, with crude OR 7.25, 95% CI 1.75–30.1. Neutrophil count and p-carbamide were not associated with BSI: adjusted OR 0.88, 95% CI 0.36–2.13 and OR 1.44, 95% CI 0.82–2.52, respectively. Only one of the sepsis score groups was associated with BSI: crude OR 2.13, 95% CI 1.08–4.19. ConclusionsSIRS is an adequate predictor of BSI. By contrast, biochemical parameters were not useful as predictors of BSI.

Abstract 2656: Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients

Abstract Background There is no literature for stratification of permanent implantable venous ports (Port-A) related bloodstream infection (BSI) in solid cancer patients. We conduct this study to characterize the risk factors of BSI associated with the use of Port-A (PABSI) in solid cancer patients. Methods The study is done in a teaching hospital in Taiwan. Solid cancer patients who were implanted with a Port-A for systemic anti-cancer therapies were prospectively followed for the occurrence of PABSI, defined as BSI without other identifiable infection foci. Patients with PABSI during the follow-up period constitute the case cohort (N = 58) and 174 patients were randomly selected from those without BSI as the control cohort. PABSI risk score was developed by Cox proportional hazards model. Results 416 patients were registered (Table 1). Eighty-eight PABSI episodes occurred in 58 patients, with an incidence of 1.05 per 1000 catheter-days. All but one patient had stage 4 cancer. Independent predictors of PABSI occurrence included neutropenia (HR = 3.86, 95% CI = 1.75-8.50), total parental nutrition (TPN) (HR = 3.51, 95% CI = 1.86-6.63), chronic steroid use (HR = 7.01, 95% CI = 2.78-17.65), invasive procedure (HR = 3.00, 95% CI = 1.29-6.98), postoperative antibiotics (HR = 2.61, 95% CI = 1.43-4.75), and preoperative antibiotics (HR = 0.38, 95% CI = 0.17-0.83). A PABSI risk score, with a cut-off value of 0 (sensitivity 88.5%, specificity 64.3%), was defined for stage 4 cancer patients as follows: neutropenia, +1.350; TPN, +1.256; chronic steroid use, +1.947; preoperative antibiotics, –0.970; postoperative antibiotics, +0.959; and invasive procedure, +1.098. The median PABSI-free survival was 4.47 months for patients with score β0 but not reached for patients with score &amp;lt; 0 (p &amp;lt; 0.0001). Conclusions The PABSI risk score can help define high-risk groups in solid cancer patients and may help design future preventive strategies. Presence of any risk factor would render patients as high risk. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2656. doi:1538-7445.AM2012-2656

Central venous catheter-associated bloodstream infection and colonisation of insertion site and catheter tip. What are the rates and risk factors in haematology patients?

Skin colonisation is an important source for central venous catheter (CVC) colonisation and infection. This study intended to identify risk factors for skin colonisation prior to CVC placement (baseline colonisation) and within 10days after CVC insertion (subsequent colonisation), for CVC-tip colonisation and for bloodstream infection (BSI). Within a randomised clinical trial, data of 219 patients with haematological malignancies and inserted CVC (with a total of 5,501 CVC-days and 4,275days at risk) in two university hospitals were analysed. Quantitative skin cultures were obtained from the insertion site before CVC placement and at regular intervals afterwards. CVC-tip cultures were taken on CVC removal and data collection was performed. Statistical analysis included linear and logistic regression models. Age was an independent risk factor for colonisation prior to CVC placement (baseline colonisation). Independent risk factors for subsequent colonisation were baseline colonisation and male gender. High level of subsequent skin colonisation at the insertion site was a predictor of CVC-tip colonisation, and a predictor of BSI. High level of skin colonisation predicts catheter tip colonisation and possibly subsequent infection. Sustained reduction of bacterial growth at the CVC insertion site is therefore indispensable. Male patients are at particular risk for skin colonisation and may be a target population for additional insertion-site care before and during catheterisation.

A Central Venous Line Protocol Decreases Bloodstream Infections and Length of Stay in a Trauma Intensive Care Unit Population

We evaluated the benefit of a central venous line (CVL) protocol on bloodstream infections (BSIs) and outcome in a trauma intensive care unit (ICU) population. We prospectively compared three groups: Group 1 (January 2003 to June 2004) preprotocol; Group 2 (July 2004 to June 2005) after the start of the protocol that included minimizing CVL use and strict universal precautions; and Group 3 (July 2005 to December 2006) after the addition of a line supply cart and nursing checklist. There were 1622 trauma patients admitted to the trauma ICU during the study period of whom 542 had a CVL. Group 3 had a higher Injury Severity Score (ISS) compared with both Groups 2 and 1 (28.3 +/- 13.0 vs 23.5 +/- 11.7 vs 22.8 +/- 12.0, P = 0.0002) but had a lower BSI rate/1000 line days (Group 1: 16.5; Group 2: 15.0; Group 3: 7.7). Adjusting for ISS group, three had shorter ICU length of stay (LOS) compared with Group 1 (12.11 +/- 1.46 vs 18.16 +/- 1.51, P = 0.01). Logistic regression showed ISS (P = 0.04; OR, 1.025; CI, 1.001-1.050) and a lack of CVL protocol (P = 0.01; OR, 0.31; CI, 0.13-0.76) to be independent predictors of BSI. CVL protocols decrease both BSI and LOS in trauma patients. Strict enforcement by a nurse preserves the integrity of the protocol.