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Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score
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 diagnosti...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685114/ https://www.ncbi.nlm.nih.gov/pubmed/32603544 http://dx.doi.org/10.1111/ijcp.13601 |
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author | Lambregts, Merel M. C. Molendijk, Eva B. D. Meziyerh, Soufian Schippers, Emile F. Delfos, Nathalie M. Leendertse, Masja Bernards, Alexandra T. Visser, Leo G. Dekkers, Olaf M. de Boer, Mark G. J. |
author_facet | Lambregts, Merel M. C. Molendijk, Eva B. D. Meziyerh, Soufian Schippers, Emile F. Delfos, Nathalie M. Leendertse, Masja Bernards, Alexandra T. Visser, Leo G. Dekkers, Olaf M. de Boer, Mark G. J. |
author_sort | Lambregts, Merel M. C. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7685114 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-76851142020-12-03 Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score Lambregts, Merel M. C. Molendijk, Eva B. D. Meziyerh, Soufian Schippers, Emile F. Delfos, Nathalie M. Leendertse, Masja Bernards, Alexandra T. Visser, Leo G. Dekkers, Olaf M. de Boer, Mark G. J. Int J Clin Pract ORIGINAL PAPERS 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. John Wiley and Sons Inc. 2020-07-14 2020-11 /pmc/articles/PMC7685114/ /pubmed/32603544 http://dx.doi.org/10.1111/ijcp.13601 Text en © 2020 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | ORIGINAL PAPERS Lambregts, Merel M. C. Molendijk, Eva B. D. Meziyerh, Soufian Schippers, Emile F. Delfos, Nathalie M. Leendertse, Masja Bernards, Alexandra T. Visser, Leo G. Dekkers, Olaf M. de Boer, Mark G. J. Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score |
title | Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score |
title_full | Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score |
title_fullStr | Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score |
title_full_unstemmed | Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score |
title_short | Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score |
title_sort | early differentiation between uncomplicated and complicated staphylococcus aureus bacteraemia: potential value and limitations of a clinical risk score |
topic | ORIGINAL PAPERS |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685114/ https://www.ncbi.nlm.nih.gov/pubmed/32603544 http://dx.doi.org/10.1111/ijcp.13601 |
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