Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score.

Autor:	Lambregts MMC; Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands., Molendijk EBD; Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.; Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands., Meziyerh S; Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.; Department of Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands., Schippers EF; Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.; Department of Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands., Delfos NM; Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands., Leendertse M; Department of Medical Microbiology, Alrijne Hospital, Leiderdorp, The Netherlands., Bernards AT; Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands., Visser LG; Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands., Dekkers OM; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands., de Boer MGJ; Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk:	angličtina
Zdroj:	International journal of clinical practice [Int J Clin Pract] 2020 Nov; Vol. 74 (11), pp. e13601. Date of Electronic Publication: 2020 Jul 14.
DOI:	10.1111/ijcp.13601
Abstrakt:	Objective: A cornerstone in the management of Staphylococcus aureus bacteraemia (SAB) is the differentiation between a complicated and an uncomplicated SAB course. The ability to early and accurately identify patients with - and without - complicated bacteraemia may optimise the utility of diagnostics and prevent unnecessary prolonged antibiotic therapy. Methods: Development and validation of a prediction score in SAB using demographic, clinical, and laboratory data from two independent Dutch cohorts; estimating the risk of complicated disease at the time of the first positive blood culture. Models were developed using logistic regression and evaluated by c-statistics, ie area under the ROC-curve, and negative predictive values (NPV). Results: The development- and validation cohorts included 150 and 183 patients, respectively. The most optimal prediction model included: mean arterial pressure, signs of metastatic infection on physical examination, leucocyte count, urea level and time to positivity of blood cultures (c-statistic 0.82, 95% CI 0.74-0.89). In the validation cohort, the c-statistic of the prediction score was 0,77 (95% CI 0.69-0.84). The NPV for complicated disease for patients with a score of ≤2 was 0.83 (95% CI 0.68-0.92), with a negative likelihood ratio of 0.14 (95% CI 0.06-0.31). Conclusion: The early SAB risk score helps to identify patients with high probability of uncomplicated SAB. However, the risk score's lacked absolute discriminative power to guide decisions on the management of all patients with SAB on its own. The heterogenicity of the disease and inconsistency in definitions of complicated SAB are important challenges in the development of clinical rules to guide the management of SAB. (© 2020 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd.)
Databáze:	MEDLINE
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