Highlights
- •We assessed the outcome of bacteremia in an intensive care unit using matching by propensity scores.
- •Intensive care unit patients with bacteremia had higher mortality and length of stay than controls.
- •We also assessed the relationship between systemic inflammatory response syndrome criteria and blood culture result in an intensive care unit.
- •There was no relationship between systemic inflammatory response syndrome and blood culture status.
- •A decision rule tool based on systemic inflammatory response syndrome criteria met cannot predict blood culture result.
Background
The purpose of this study was to determine the impact of bacteremia on intensive care
unit (ICU) mortality and to develop a bacteremia prediction tool using systemic inflammatory
response syndrome (SIRS) criteria.
Methods
Patients included those aged >18 years who had blood cultures taken in the ICU from
January 1, 2011-December 31, 2013. Eligible patients were identified from microbiology
records of the Glasgow Royal Infirmary, Scotland. Clinical and outcome data were gathered
from ICU records. Patients with clinically significant bacteremia were matched to
controls using propensity scores. SIRS criteria were gathered and used to create decision
rules to predict the absence of bacteremia. The main outcome was mortality at ICU
discharge. The utility of the decision tools was measured using sensitivity and specificity.
Results
One hundred patients had a clinically significant positive blood culture and were
matched to 100 controls. Patients with bacteremia had higher ICU mortality (odds ratio
[OR], 2.35; P = .001) and longer ICU stay (OR, 17.0 vs 7.8 days; P ≤ .001). Of 1,548 blood culture episodes, 1,274 met ≥2 SIRS criteria (106 significant
positive cultures and 1,168 negative cultures). There was no association between SIRS
criteria and positive blood cultures (P = .11). A decision rule using 3 SIRS criteria had optimal predictive performance
(sensitivity, 56%; specificity, 50%) but low accuracy.
Conclusions
ICU patients with bacteremia have increased mortality and length of ICU stay. SIRS
criteria cannot be used to identify patients at low risk of bacteremia.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- International study of the prevalence and outcomes of infection in intensive care units.JAMA. 2009; 302: 2323-2329
- The era of molecular and other non-culture-based methods in diagnosis of sepsis.Clin Microbiol Rev. 2010; 23: 235-251
- Bloodstream infection-associated sepsis and septic shock in critically ill adults: a population-based study.Infection. 2004; 32: 59-64
- Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study.Lancet Infect Dis. 2011; 11: 30-38
- Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality.Crit Care. 2011; 15: R100
- Does this adult patient with suspected bacteraemia require blood cultures? Blood cultures for bacteraemia.JAMA. 2012; 308: 502-511
- How bad are bacteraemia and sepsis?: Outcomes in a cohort with suspected bacteraemia.Arch Intern Med. 1995; 155: 593-598
- Current approaches to the diagnosis of bacterial and fungal bloodstream infections in the intensive care unit.Crit Care Med. 2012; 40: 3277-3282
- The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis.QJM. 1996; 89: 515-522
- Factors associated with positive blood cultures in outpatients with suspected bacteraemia.Eur J Clin Microbiol Infect Dis. 2011; 30: 1615-1619
- Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine.Chest. 1992; 101: 1644-1655
- Impact of inactive empiric antimicrobial therapy on inpatient mortality and length of stay.Antimicrob Agents Chemother. 2006; 50: 3355-3360
- Current blood culture methods and systems: clinical concepts, technology, and interpretation of results.Clin Infect Dis. 1996; 23: 40-46
- Predictors of positive blood cultures in critically ill patients: a retrospective evaluation.Croat Med J. 2012; 53: 30-39
- The clinical and prognostic importance of positive blood cultures in adults.Am J Med. 2010; 123: 819-828
- The central role of the propensity score in observational studies for causal effects.Biometrika. 1983; 70: 41-55
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424
- Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units.J Am Med Assoc. 1995; 274: 968-974
- Excess risk of death from intensive care unit—acquired nosocomial bloodstream infections: a reappraisal.Clin Infect Dis. 2006; 42: 1118-1126
- The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC case mix programme database.Crit Care. 2006; 10: R42
- Variation in critical care services across North America and Western Europe.Crit Care Med. 2008; 36 (e1-9): 2787-2793
- Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.Crit Care Med. 2006; 34: 1589-1596
Article Info
Publication History
Published online: June 20, 2016
Footnotes
Conflicts of Interest: None to report.
Author Contributions: D.B. was the principal investigator and had access to all of the data in the study. Conception and design of the study was carried out by D.B., A.S., D.Y., and M.G.B. Analysis and interpretation of the data were performed by D.B. and R.F. The first draft of the manuscript was prepared by D.B. D.B., A.S., D.Y. and M.G.B. critically reviewed the manuscript for important intellectual content.
Identification
Copyright
Crown Copyright © 2016 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.
