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Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults

OBJECTIVES: Bloodstream infection is associated with high mortality rates in critically ill patients but is difficult to identify clinically. This results in frequent blood culture testing, exposing patients to additional costs as well as the potential harms of unnecessary antibiotics. The purpose o...

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Autores principales: Zimmet, Alex N., Clark, Matthew T., Gadrey, Shrirang M., Bell, Taison D., Zimmet, Amanda M., Moorman, J. Randall, Moore, Christopher C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523775/
https://www.ncbi.nlm.nih.gov/pubmed/33063017
http://dx.doi.org/10.1097/CCE.0000000000000191
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author Zimmet, Alex N.
Clark, Matthew T.
Gadrey, Shrirang M.
Bell, Taison D.
Zimmet, Amanda M.
Moorman, J. Randall
Moore, Christopher C.
author_facet Zimmet, Alex N.
Clark, Matthew T.
Gadrey, Shrirang M.
Bell, Taison D.
Zimmet, Amanda M.
Moorman, J. Randall
Moore, Christopher C.
author_sort Zimmet, Alex N.
collection PubMed
description OBJECTIVES: Bloodstream infection is associated with high mortality rates in critically ill patients but is difficult to identify clinically. This results in frequent blood culture testing, exposing patients to additional costs as well as the potential harms of unnecessary antibiotics. The purpose of this study was to assess whether the analysis of bedside physiologic monitoring data could accurately describe a pathophysiologic signature of bloodstream infection in patients admitted to the ICU. DESIGN: Development of a statistical model using physiologic data from a retrospective observational cohort. SETTING: University of Virginia Medical Center (Charlottesville, VA), a tertiary-care academic medical center. PATIENTS: Critically ill patients consecutively admitted to either the medical or surgical/trauma ICUs with available physiologic monitoring data between February 2011 and June 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 9,954 ICU admissions with 144 patient-years of vital sign and electrocardiography waveform data, totaling 1.3 million hourly measurements. There were 15,577 blood culture instances, with 1,184 instances of bloodstream infection (8%). The multivariate pathophysiologic signature of bloodstream infection was characterized by abnormalities in 15 different physiologic features. The cross-validated area under the receiver operating characteristic curve was 0.78 (95% CI, 0.69–0.85). We also identified distinct signatures of Gram-negative and fungal bloodstream infections, but not Gram-positive bloodstream infection. CONCLUSIONS: Signatures of bloodstream infection can be identified in the routine physiologic monitoring data of critically ill adults. This may assist in identifying infected patients, maximizing diagnostic stewardship, and measuring the effect of new therapeutic modalities for sepsis.
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spelling pubmed-75237752020-10-14 Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults Zimmet, Alex N. Clark, Matthew T. Gadrey, Shrirang M. Bell, Taison D. Zimmet, Amanda M. Moorman, J. Randall Moore, Christopher C. Crit Care Explor Original Clinical Report OBJECTIVES: Bloodstream infection is associated with high mortality rates in critically ill patients but is difficult to identify clinically. This results in frequent blood culture testing, exposing patients to additional costs as well as the potential harms of unnecessary antibiotics. The purpose of this study was to assess whether the analysis of bedside physiologic monitoring data could accurately describe a pathophysiologic signature of bloodstream infection in patients admitted to the ICU. DESIGN: Development of a statistical model using physiologic data from a retrospective observational cohort. SETTING: University of Virginia Medical Center (Charlottesville, VA), a tertiary-care academic medical center. PATIENTS: Critically ill patients consecutively admitted to either the medical or surgical/trauma ICUs with available physiologic monitoring data between February 2011 and June 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 9,954 ICU admissions with 144 patient-years of vital sign and electrocardiography waveform data, totaling 1.3 million hourly measurements. There were 15,577 blood culture instances, with 1,184 instances of bloodstream infection (8%). The multivariate pathophysiologic signature of bloodstream infection was characterized by abnormalities in 15 different physiologic features. The cross-validated area under the receiver operating characteristic curve was 0.78 (95% CI, 0.69–0.85). We also identified distinct signatures of Gram-negative and fungal bloodstream infections, but not Gram-positive bloodstream infection. CONCLUSIONS: Signatures of bloodstream infection can be identified in the routine physiologic monitoring data of critically ill adults. This may assist in identifying infected patients, maximizing diagnostic stewardship, and measuring the effect of new therapeutic modalities for sepsis. Lippincott Williams & Wilkins 2020-09-23 /pmc/articles/PMC7523775/ /pubmed/33063017 http://dx.doi.org/10.1097/CCE.0000000000000191 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Clinical Report
Zimmet, Alex N.
Clark, Matthew T.
Gadrey, Shrirang M.
Bell, Taison D.
Zimmet, Amanda M.
Moorman, J. Randall
Moore, Christopher C.
Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults
title Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults
title_full Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults
title_fullStr Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults
title_full_unstemmed Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults
title_short Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults
title_sort pathophysiologic signatures of bloodstream infection in critically ill adults
topic Original Clinical Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523775/
https://www.ncbi.nlm.nih.gov/pubmed/33063017
http://dx.doi.org/10.1097/CCE.0000000000000191
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