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Clinical index to predict bacteraemia caused by staphylococci
Author(s) -
LEIBOVICI L.,
GRANSDEN W. R.,
EYKYN S. J.,
KONSIBERGER H.,
DRUCKER M.,
PITLIK S. D.,
PHILLIPS I.
Publication year - 1993
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.1993.tb00709.x
Subject(s) - medicine , bacteremia , staphylococcus aureus , observational study , coagulase , methicillin resistant staphylococcus aureus , logistic regression , prospective cohort study , antibiotics , staphylococcal infections , staphylococcus , microbiology and biotechnology , genetics , bacteria , biology
. Objectives . To define risk factors associated with bacteraemia caused by Staphylococcus aureus or coagulase‐negative staphylococci; and to use them to define patients in need of empiric anti‐staphylococcal antibiotic treatment. Design , Derivation set: observational, prospective study; validation set: retrospective analysis of a prospectively collected database. Setting . Derivation set: Beilinson Medical Centre, Petah Tiqva, Israel—a 900‐bed university hospital. Validation set: St Thomas's Hospital, London, UK—an 800‐bed teaching hospital. Subjects . All episodes of bacteraemia detected at Beilinson Medical Centre between March 1988 and September 1990 (derivation set, n = 1410), and at St Thomas's Hospital during 1987–1990 (validation set, n = 1040). Interventions . None. Main outcome measures . Percentage of staphylococcal bacteraemia in groups of patients defined by the models. Results . The following factors were associated with Staphylococcus aureus bacteraemia: focus of infection (whether high or low risk), haemodialysis, intravenous drug abuse and infection acquired in the orthopaedic ward. A logistic model was used to divide the derivation set into three groups with percentages of Staphylococcus aureus bacteraemia of 1.8%, 13.2% and 33.7% ( P < 0.0001); and the validation group 2.5%, 18.2% and 53.2% ( P < 0.0001). Factors associated with coagulase‐negative staphylococcal bacteraemia were: central or peripheral intravenous catheter as the focus of infection, a preterm neonate, the presence of a central intravenous catheter, low temperature, and a low white blood cell count. A second model including those factors was used to divide the derivation set into three groups with percentages of coagulase‐negative staphylococcal bacteraemia of 1.9%, 22.8%, and 43% ( P < 0.0001). In the validation set, the percentages were 2.9%, 22.4% and 31.0% ( P < 0.001). Conclusions . The present study defines groups at high risk for staphylococcal bloodstream infection, in which empiric treatment should include an anti‐staphylococcal drug.