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
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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.
