Open Access
Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score
Author(s) -
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.,
Boer Mark G. J.
Publication year - 2020
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.13601
Subject(s) - medicine , logistic regression , cohort , framingham risk score , receiver operating characteristic , disease , surgery , intensive care medicine
Abstract 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.