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Clin Infect Dis. 2019 Jun 19. pii: ciz528. doi: 10.1093/cid/ciz528. [Epub ahead of print]

The Pitt Bacteremia Score Predicts Mortality in Non-Bacteremic Infections.

Author information

1
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America.
2
Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America.
3
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, United States of America.
4
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America.
5
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.
6
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States of America.
7
Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio, United States of America.
8
Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, Ohio, United States of America.
9
Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
10
Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, United States of America.
11
Department of Biostatistics, George Washington University, Washington DC, United States of America.
12
Division of Infectious Diseases, Duke University, Durham, North Carolina, United States of America.
13
Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America.
14
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
15
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America.
16
Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
17
CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES) Cleveland, OH, USA.
18
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.

Abstract

BACKGROUND:

Predicting mortality risk in patients is important in research settings. The Pitt bacteremia score (PBS) is commonly used as a predictor of early mortality risk in patients with bloodstream infections (BSI). Here, we determined whether the PBS predicts 14-day inpatient mortality in non-bacteremia carbapenem-resistant Enterobacteriaceae (CRE) infections.

METHODS:

Patients were selected from the Consortium on resistance against carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-1), a prospective, multicenter, observational study. We estimated risk ratios to analyze the predictive ability of the PBS overall and each of its components individually. We analyzed each component of the PBS in the prediction of mortality, assessed the appropriate cutoff value for the dichotomized score, and compared the predictive ability of the qPitt score to that of the PBS.

RESULTS:

In a cohort of 475 patients with CRE infections, a PBS ≥ 4 was associated with mortality in patients with non-bacteremia infections (RR=21.9 [95% CI: 7.0, 68.8]) and with BSI (RR=6.0 [95% CI: 2.5, 14.4]). In multivariable analysis, the hypotension, mechanical ventilation, mental status, and cardiac arrest parameters of the PBS were independent risk factors for 14-day all-cause inpatient mortality. The temperature parameter as originally calculated for the PBS was not independently associated with mortality. However, a temperature < 36.0ᴼ C versus ≥ 36ᴼ C was independently associated with mortality. A qPitt score ≥ 2 had similar discrimination as a PBS ≥ 4 in non-bacteremia infections.

CONCLUSION:

Here, we validated that the PBS and qPitt score can be used as reliable predictors of mortality in non-bacteremia CRE infections.

PMID:
31219148
DOI:
10.1093/cid/ciz528

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