Risk Of Bacteremia In Patients Research Articles

QSOFA does not predict bacteremia in patients with severe manifestations of sepsis.

Bloodstream infections in septic patients may be missed due to preceding antibiotic therapy prior to obtaining blood cultures. We leveraged the FABLED cohort study to determine if the quick Sequential Organ Failure Assessment (qSOFA) score could reliably identify patients at higher risk of bacteremia in patients who may have false negative blood cultures due to previously administered antibiotic therapy. We conducted a multi-centre diagnostic study among adult patients with severe manifestations of sepsis. Patients were enrolled in one of seven participating centres between November 2013 and September 2018. All patients from the FABLED cohort had two sets of blood cultures drawn prior to the administration of antimicrobial therapy, as well as additional blood cultures within 4 hours of treatment initiation. Participants were categorized according to qSOFA score, with a score ≥2 being considered positive. Among 325 patients with severe manifestations of sepsis, a positive qSOFA score (defined as a score ≥2) on admission was 58% sensitive (95% CI 48% to 67%) and 41% specific (95% CI 34% to 48%) for predicting bacteremia. Among patients with negative post-antimicrobial blood cultures, a positive qSOFA score was 57% sensitive (95% CI 42% to 70%) and 42% specific (95% CI 35% to 49%) to detect patients who were originally bacteremic prior to the initiation of therapy. Our results suggest that the qSOFA score cannot be used to identify patients at risk for occult bacteremia due to the administration of antibiotics pre-blood culture.

Dialysis access as a source of infective endocarditis in dialysis patients

The incidence of Infective Endocarditis (IE) is higher in dialysis patients compared to the general population. A major risk factor for IE in this group stems from bacterial invasion during repeated vascular access. Previous studies have shown increased risk of bacteremia in patients with indwelling dialysis catheters compared to permanent vascular access. However, association between the development of IE and the type of dialysis access is unclear. We aimed to examine the associated types of intravascular access and route of infection in dialysis patients who were admitted with infective endocarditis at our center.All patients admitted to Albert Einstein Medical Center in Philadelphia with a diagnosis of infective endocarditis who were on chronic hemodialysis were identified from the hospital database for the period of 1/1/07 to 12/31/18. Modified Duke criteria was used to confirm the diagnosis of infective endocarditis. A total of 96 cases were identified. Of those, 57 patients had an indwelling dialysis catheter while the other 39 had permanent dialysis access. In 82% of patients with dialysis catheters, their dialysis access site was identified as the primary source of infection compared to 30% in those with permanent dialysis access (p<0.001). The number of dialysis catheters placed in the preceding 6 months was strongly associated with endocarditis resulting from the dialysis access site (OR = 3.202, p=0.025). Dialysis catheters are more likely to serve as the source of infection in dialysis patients developing IE compared to permanent dialysis access. Increased awareness of risk of IE associated with dialysis catheters is warranted.

Risk of bacteremia in patients with cutaneous T-cell lymphoma (CTCL)

Patients with CTCL are at increased risk for bacteremia which is a leading cause of morbidity and mortality. We assessed risk factors for and the impact of bacteremia on survival in a retrospective cohort of 188 CTCL patients at a single US academic institution treated between 1990 and 2018. With a median follow up of 6.2 years, 20% of patients (n = 36) developed 79 bacteremia events. Risk factors for bacteremia included advanced stage, female gender, African American (AA) race, invasive lines, and chemotherapy. Bacteremia was associated with an increased risk of death on univariate and multivariable models. Bacteremia is associated with an increased risk of death in patients with CTCL. The greatest avoidable risk factors included chemotherapy treatment and presence of an invasive line. Key points 20% of patients developed bacteremia at any point in time in this analysis. Bacteremia is associated with an increased risk of death in patients with CTCL Risk factors for bacteremia include advanced stage, female gender, AA race, invasive line, and chemotherapy.

Risk of bacteremia in patients presenting with shaking chills and vomiting - a prospective cohort study.

Chills and vomiting have traditionally been associated with severe bacterial infections and bacteremia. However, few modern studies have in a prospective way evaluated the association of these signs with bacteremia, which is the aim of this prospective, multicenter study. Patients presenting to the emergency department with at least one affected vital sign (increased respiratory rate, increased heart rate, altered mental status, decreased blood pressure or decreased oxygen saturation) were included. A total of 479 patients were prospectively enrolled. Blood cultures were obtained from 197 patients. Of the 32 patients with a positive blood culture 11 patients (34%) had experienced shaking chills compared with 23 (14%) of the 165 patients with a negative blood culture, P = 0.009. A logistic regression was fitted to show the estimated odds ratio (OR) for a positive blood culture according to shaking chills. In a univariate model shaking chills had an OR of 3.23 (95% CI 1.35-7.52) and in a multivariate model the OR was 5.9 (95% CI 2.05-17.17) for those without prior antibiotics adjusted for age, sex, and prior antibiotics. The presence of vomiting was also addressed, but neither a univariate nor a multivariate logistic regression showed any association between vomiting and bacteremia. In conclusion, among patients at the emergency department with at least one affected vital sign, shaking chills but not vomiting were associated with bacteremia.

Colonization with Ceftriaxone-resistant Enterobacteriaceae and Risk of Bacteremia in Patients Receiving Induction Chemotherapy for Acute Leukemia

Colonization with Ceftriaxone-resistant Enterobacteriaceae and Risk of Bacteremia in Patients Receiving Induction Chemotherapy for Acute Leukemia

Development of a prediction model for bacteremia in hospitalized adults with cellulitis to aid in the efficient use of blood cultures: a retrospective cohort study.

BackgroundCellulitis is a common infectious disease. Although blood culture is frequently used in the diagnosis and subsequent treatment of cellulitis, it is a contentious diagnostic test. To help clinicians determine which patients should undergo blood culture for the management of cellulitis, a diagnostic scoring system referred to as the Bacteremia Score of Cellulitis was developed.MethodsUnivariable and multivariable logistic regression analyses were performed as part of a retrospective cohort study of all adults diagnosed with cellulitis in a tertiary teaching hospital in Taiwan in 2013. Patients who underwent blood culture were used to develop a diagnostic prediction model where the main outcome measures were true bacteremia in cellulitis cases. Area under the receiver operating characteristics curve (AUC) was used to demonstrate the predictive power of the model, and bootstrapping was then used to validate the performance.ResultsThree hundred fifty one cases with cellulitis who underwent blood culture were enrolled. The overall prevalence of true bacteremia was 33/351 cases (9.4 %). Multivariable logistic regression analysis showed optimal diagnostic discrimination for the combination of age ≥65 years (odds ratio [OR] = 3.9; 95 % confidence interval (CI), 1.5–10.1), involvement of non-lower extremities (OR = 4.0; 95 % CI, 1.5–10.6), liver cirrhosis (OR = 6.8; 95 % CI, 1.8–25.3), and systemic inflammatory response syndrome (SIRS) (OR = 15.2; 95 % CI, 4.8–48.0). These four independent factors were included in the initial formula, and the AUC for this combination of factors was 0.867 (95 % CI, 0.806–0.928). The rounded formula was 1 × (age ≥65 years) + 1.5 × (involvement of non-lower extremities) + 2 × (liver cirrhosis) + 2.5 × (SIRS). The overall prevalence of true bacteremia (9.4 %) in this study could be lowered to 1.0 % (low risk group, score ≤1.5) or raised to 14.7 % (medium risk group, score 2–3.5) and 41.2 % (high risk group, score ≥4.0), depending on different clinical scores.ConclusionsDetermining the risk of bacteremia in patients with cellulitis will allow a more efficient use of blood cultures in the diagnosis and treatment of this condition. External validation of this preliminary scoring system in future trials is needed to optimize the test.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1907-2) contains supplementary material, which is available to authorized users.

Factors influencing bacteraemia in patients with isomerism and CHD: the effects of functional splenic status and antibiotic prophylaxis.

"Heterotaxy syndrome", best segregated as isomerism, is characterised by laterality defects of the thoraco-abdominal organs, causing functional impairment. In particular, the spleen is frequently affected, increasing susceptibility to bacteraemia. This study explored factors that may increase the risk of bacteraemia in patients with isomerism. We identified patients with CHD and isomerism. Review of outpatient, inpatient, and surgical records was conducted to collect data and determine trends in the cohort. A Cox regression analysis was conducted to determine factors influencing freedom from bacteraemia (Fig 1). We identified 83 patients with CHD and isomerism - 17 (20%) who had documented episodes of bacteraemia with a total of 21 episodes. A majority (86%) were nosocomial. The median age at the time of bacteraemia was 4 months. Although splenic anatomy did appear to influence the risk of bacteraemia in univariate analysis, this significance was lost with multivariate analysis. None of the other factors was significantly associated in either univariate or multivariate analysis. Specific factors such as splenic anatomy, atrial appendage isomerism, and antibiotic prophylaxis status are not significantly associated with the risk of bacteraemia in patients with CHD and isomerism. Nosocomial infections represent a majority of bacteraemia in these patients.

Antibacterial Prophylaxis Reduces the Risk of Bacteremia in Patients with Multiple Myeloma and Lymphoma Undergoing High-Dose Chemotherapy and Autologous Stem Cell Transplantation

Antibacterial Prophylaxis Reduces the Risk of Bacteremia in Patients with Multiple Myeloma and Lymphoma Undergoing High-Dose Chemotherapy and Autologous Stem Cell Transplantation

Blood Cultures for Evaluation of Early Postoperative Fever after Femoral Neck Fracture Surgery

To evaluate the utility of blood cultures in the assessment of early postoperative fever in hip fracture patients with no other indicators of sepsis. 101 blood cultures were drawn on postoperative days 0 to 5 to investigate 84 febrile episodes in 31 women and 30 men (mean age, 80 years) whose body temperature measured via the tympanic route was ≥ 38 ºC. Culture results of these 61 patients were divided into culture-positive and culture-negative groups for comparison. Of the 101 blood cultures, only 2 were positive: one was obtained 5 days after dynamic hip screw fixation, and the other 4 days after hemiarthroplasty. Both blood cultures grew coagulase-negative staphylococcal species, which were deemed to be skin contaminants not requiring change of patient management. 44 of these patients were treated with oral or intravenous antibiotics for a period of time. The risk of bacteraemia in patients with postoperative fever but no other symptoms of infection is low. Routine procurement of blood cultures in such patients is ineffective and of limited utility.

Intestinal Domination and the Risk of Bacteremia in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Bacteremia is a frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). It is unclear whether changes in the intestinal microbiota during allo-HSCT contribute to the development of bacteremia. We examined the microbiota of patients undergoing allo-HSCT, and correlated microbial shifts with the risk of bacteremia. Fecal specimens were collected longitudinally from 94 patients undergoing allo-HSCT, from before transplant until 35 days after transplant. The intestinal microbiota was characterized by 454 pyrosequencing of the V1-V3 region of bacterial 16S ribosomal RNA genes. Microbial diversity was estimated by grouping sequences into operational taxonomic units and calculating the Shannon diversity index. Phylogenetic classification was obtained using the Ribosomal Database Project classifier. Associations of the microbiota with clinical predictors and outcomes were evaluated. During allo-HSCT, patients developed reduced diversity, with marked shifts in bacterial populations inhabiting the gut. Intestinal domination, defined as occupation of at least 30% of the microbiota by a single predominating bacterial taxon, occurred frequently. Commonly encountered dominating organisms included Enterococcus, Streptococcus, and various Proteobacteria. Enterococcal domination was increased 3-fold by metronidazole administration, whereas domination by Proteobacteria was reduced 10-fold by fluoroquinolone administration. As a predictor of outcomes, enterococcal domination increased the risk of Vancomycin-resistant Enterococcus bacteremia 9-fold, and proteobacterial domination increased the risk of gram-negative rod bacteremia 5-fold. During allo-HSCT, the diversity and stability of the intestinal flora are disrupted, resulting in domination by bacteria associated with subsequent bacteremia. Assessment of fecal microbiota identifies patients at highest risk for bloodstream infection during allo-HCST.

A Prediction Rule for Estimating the Risk of Bacteremia in Patients with Community‐Acquired Pneumonia

We endeavored to construct a simple score based entirely on epidemiological and clinical variables that would stratify patients who require hospital admission because of community-acquired pneumonia into groups with a low or high risk of developing bacteremia. Derivation and internal validation cohorts were obtained by retrospective analysis of a database that included 3116 consecutive patients with community-acquired pneumonia from 2 university hospitals. Potential predictive factors were determined by means of a multivariate logistic regression equation applied to a cohort consisting of 60% of the patients. Points were assigned to significant parameters to generate the score. It was then internally validated with the remaining 40% of patients and was externally validated using an independent multicenter cohort of 1369 patients. The overall rates of bacteremia were 12%-16% in the cohorts. The clinical probability estimate of developing bacteremia was based on 6 variables: liver disease, pleuritic pain, tachycardia, tachypnea, systolic hypotension, and absence of prior antibiotic treatment. For the score, 1 point was assigned to each predictive factor. In the derivation cohort, a cutoff score of 2 best identified the risk of bacteremia. In the validation cohorts, rates of bacteremia were <8% for patients with a score 1 (43%-49% of patients), whereas blood culture results were positive in 14%-63% of cases for patients with a score 2. This clinical score, based on readily available and objective variables, provides a useful tool to predict bacteremia. The score has been internally and externally validated and may be useful to guide diagnostic decisions for community-acquired pneumonia.

Risk of Bacteremia in Patients with Hematological and other Malignancies after Initial Placement of a Central Venous Catheter

Widespread use of central venous access devices has made catheter-related bacteremia an important concern. Therefore, we conducted a follow-up study on the risk of bacteremia in Danish patients with hematological or other malignancies after placement of their first central venous access devise. At a Danish university hospital we identified 357 patients with hematological or other malignancies during a three-year period, 2000-2002. Data on catheter placement and bacteremias were obtained from hospital registries. Clinical data were abstracted from patients' charts. 104 patients had a hematological malignancy (hem) and 253 patients had other malignancies (solid tumor). A total of 55 patients (34/21) developed bacteremia following catheter placement. After adjustment for age, sex, and comorbidity, the relative risk of bacteremia in the hem compared with the solid tumor group was 10.8 (95%; CI, 5.8-20.1). In both groups, the central venous catheter was the most frequent focus of infection with no major difference in proportion (50% and 33%, respectively); an unknown focus was also common (50% and 19%, respectively). Patients with hematological malignancies had a 10-fold increased risk of bacteremia compared with other cancer patients and the central venous catheter was not the only important focus.

The degree of chills for risk of bacteremia in acute febrile illness

Purpose Patients with acute febrile illness may experience different degrees of chills. To evaluate the different degrees of chills in predicting risk of bacteremia in patients with acute febrile illness, we performed a single-center prospective observational study. Methods We enrolled consecutive adult patients with acute febrile illness presenting to our emergency department. We defined mild chills as cold-feeling equivalent such as the need of an outer jacket; moderate chills as the need for a thick blanket; and shaking chills as whole-body shaking even under a thick blanket. We estimated risk ratios of the different degrees of chills for bacteremia using multivariable adjusted Poisson regression. Results Of a total 526 patients, 40 patients (7.6%) had bacteremia. There were 65 patients (12.4%) with shaking chills, 100 (19%) with moderate chills, and 105 (20%) with mild chills. By comparing patients with no chills, the risk ratios of bacteremia were 12.1 (95% confidence interval [CI] 4.1-36.2) for shaking chills, 4.1 (95% CI 1.6-10.7) for moderate chills, and 1.8 (95% CI 0.9-3.3) for mild chills. Shaking chills showed a specificity of 90.3% (95% CI 89.2-91.5) and positive likelihood ratio of 4.65 (95% CI 2.95-6.86). The absence of chills showed a sensitivity of 87.5% (95% CI 74.4-94.5) and negative likelihood ratio of 0.24 (95% CI 0.11-0.51). Conclusion Evaluation of the degree of chills is important for estimating risk of bacteremia in patients with acute febrile illness. The more severe degree of chills suggests the higher risk of bacteremia.

Population‐Based Study of the Risk and Short‐Term Prognosis for Bacteremia in Patients with Liver Cirrhosis

We examined the risk of bacteremia in patients with liver cirrhosis (compared with the risk for all Danish citizens >20 years of age who were living in North Jutland County, Denmark), as well as the type of bacteremia and the 30-day case-fatality rate. We used the Danish National Registry of Patients to identify 1339 patients with liver cirrhosis, and we used the North Jutland County Bacteremia Database to identify episodes of bacteremia. We observed 117 cases of bacteremia in patients with liver cirrhosis (11.0 cases were expected), which yielded a standardized incidence ratio of 10.5 (95% confidence interval [CI], 8.8-12.7). Sixty-two cases of bacteremia were nosocomial infections. There were 53 cases of gram-positive bacteremia, 55 cases of gram-negative bacteremia, and 8 cases of polymicrobial bacteremia (1 case of candidemia was excluded from the analysis). The most common cause of death was bleeding from gastroesophageal varices; the second most common cause of death was infection in the respiratory system. The 30-day case-fatality rate was 0.53 (95% CI, 0.39-0.73). Patients with liver cirrhosis had an increased risk of bacteremia and a poor prognosis.

The risk of bacteremia in patients with monoclonal gammopathy of undetermined significance

We estimated the risk of bacteremia in patients with monoclonal gammopathy of undetermined significance (MGUS) compared with the general population; 1237 cases of MGUS were identified by linking information on detected monoclonal components in the North Jutland County with the Danish Cancer Registry. We evaluated the risk of bacteremia in the MGUS cohort during the 13-yr period from 1981 to 1993 by linkage to the Bacteremia Registry in the County. Follow-up for the occurrence of bacteremia started 30 d after detection of the M-component and continued until malignant transformation, death or until 31 December 1993, whichever came first. The expected numbers of bacteremia was based upon county, age, sex and period-specific incidence rates. The median follow-up period was 3.8 yr. Forty episodes of bacteremia occurred during 5500 person-years versus 18 expected. The crude standardized incidence ratio of bacteremia was 2.2 (95% confidence interval, 1.6-3.0). There was no distinct pattern of bacterial etiology in the MGUS cohort. Although we found an association between MGUS and risk of bacteremia, the overall risk is small and this finding hardly affects the clinical handling of MGUS patients.

Increased Risk of Bacteremia in Patients Hemodialyzed Through Central Catheters

As part of an ongoing prospective survey of nosocomial bacteremias, patients developing bacteremia while undergoing in-centre hemodialysis were observed over a 23 month period. Thirty-six episodes of bacteremia occurred in 30 patients: every episode was directly attributable to hemodialysis. In 28 of the 36 episodes (78%), there was evidence of inflammation with or without drainage of pus at the hemodialysis access site. Staphylococcus aureus accounted for 76% of the bacteremic isolates. Patients hemodialyzing through central venous catheters had a far higher incidence of bacteremia (0.01 per dialysis run) than patients hemodialyzing through vascular grafts (0.0005 per dialysis run).