TY - JOUR
T1 - The Pitt Bacteremia Score Predicts Mortality in Nonbacteremic Infections
AU - Henderson, Heather
AU - Luterbach, Courtney L.
AU - Cober, Eric
AU - Richter, Sandra S.
AU - Salata, Robert A.
AU - Kalayjian, Robert C.
AU - Watkins, Richard R.
AU - Doi, Yohei
AU - Kaye, Keith S.
AU - Evans, Scott
AU - Fowler, Vance G.
AU - Bonomo, Robert A.
AU - Harris, Anthony
AU - Napravnik, Sonia
AU - Van Duin, David
N1 - Funding Information:
Financial support. This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID) of the NIH under awards UM1AI104681 and R21AI114508 and by funding to D. v. D. from the Clinical and Translational Science Collaborative of Cleveland (UL1TR000439) from the National Center for Advancing Translational Sciences component of the NIH and NIH Roadmap for Medical Research. V. G. F. was supported by a Mid-Career Mentoring award (K24-AI093969) from the NIH. In addition, research reported in this publication was supported in part by the NIAID of the NIH under awards R21AI114508 (D. v. D. and R. A. B.) and R01AI100560, R01AI063517, and R01AI072219 (R. A. B.). This study was supported in part by funds and/or facilities provided by the Cleveland Department of Veterans Affairs award 1I01BX001974 to R. A. B. from the Biomedical Laboratory Research & Development Service of the Veterans Affairs Office of Research and Development and the Geriatric Research Education and Clinical Center Veterans Integrated Service Network 10 (R. A. B.). Further support came from the Research Program committees of the Cleveland Clinic (D. v. D.), an unrestricted research grant from the
Funding Information:
STERIS Corporation (D. v. D.). Y. D. was supported by research awards R01AI104895, R21AI123747, and R21AI135522 from the NIH. K. S. K. is supported by the NIAID (Division of Microbiology and Infectious Diseases protocol 10-0065 and R01AI119446-01).
Funding Information:
Potential conflicts of interest. S. E.: grants from NIAID/NIH during the conduct of the study and personal fees from Takeda/Millennium, Pfizer, Roche, Novartis, Achaogen, Huntington’s Study Group, ACTTION, Genentech, Amgen, GlaxoSmithKline, the American Statistical Association, the US Food and Drug Administration, Osaka University, National Cerebral and Cardiovascular Center of Japan, Society for Clinical Trials, Statistical Communications in Infectious Diseases (DeGruyter), AstraZeneca, Teva, Austrian Breast & Colorectal Cancer Study Group/ Breast International Group and the Alliance Foundation Trials, Zeiss, Dexcom, American Society for Microbiology, Taylor and Francis, Claret Medical, Vir, Arrevus, Five Prime, Shire, Alexion, Gilead, Spark, Clinical Trials Transformation Initiative, Nuvelution, Tracon, Deming Conference, Antimicrobial Resistance and Stewardship Conference, World Antimicrobial Congress, WAVE, Advantagene, Braeburn, Cardinal Health, Lipocine, Microbiotix, and Stryker, all outside the submitted work. S. S. R.: research support from bioMerieux, BD Diagnostics, Roche, Hologic, Diasorin, Roche, Affinity Biosensors, Accelerate, OpGen, and BioFire. R. A. B.: grant/research support from Achaogen, Allecra, Entasis, Merck, Roche, Shionogi, and Wockhardt. V. G. F.: served as chair of the V710 Scientific Advisory Committee (Merck); has received grant support from Cerexa/Actavis/Allergan, Pfizer, Advanced Liquid Logics, NIH, MedImmune, Basilea Pharmaceutica, Karius, ContraFect, Regeneron Pharmaceuticals, and Genentech; has NIH Small Business Technology Transfer/Small Business Innovation Research grants pending with Affinergy, Locus, and Medical Surface, Inc; has been a consultant for Achaogen, AmpliPhi Biosciences, Astellas Pharma, Arsanis, Affinergy, Basilea Pharmaceutica, Bayer, Cerexa Inc., ContraFect, Cubist, Debiopharm, Durata Therapeutics, Grifols, Genentech, MedImmune, Merck, the Medicines Company, Pfizer, Novartis, NovaDigm Therapeutics Inc, Theravance Biopharma, Inc, and XBiotech; has received honoraria from Theravance Biopharma, Inc and Green Cross; and has a patent pending in sepsis diagnostics. D. v. D. served on advisory boards for Actavis, Tetraphase, Sanofi-Pasteur, MedImmune, Astellas, Merck, Allergan, T2Biosystems, Roche, Achaogen, Neumedicine, and Shionogi and has received research funding from Steris Inc and Scynexis. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Background. Predicting mortality risk in patients is important in research settings. The Pitt bacteremia score (PBS) is commonly used as a predictor of early mortality risk in patients with bloodstream infections (BSIs). We determined whether the PBS predicts 14-day inpatient mortality in nonbacteremia carbapenem-resistant Enterobacteriaceae (CRE) infections. Methods. Patients were selected from the Consortium on Resistance Against Carbapenems in Klebsiella and Other Enterobacteriaceae, a prospective, multicenter, observational study. We estimated risk ratios to analyze the predictive ability of the PBS overall and each of its components individually. We analyzed each component of the PBS in the prediction of mortality, assessed the appropriate cutoff value for the dichotomized score, and compared the predictive ability of the qPitt score to that of the PBS. Results. In a cohort of 475 patients with CRE infections, a PBS 4 was associated with mortality in patients with nonbacteremia infections (risk ratio [RR], 21.9 95% confidence interval [CI], 7.0, 68.8) and with BSIs (RR, 6.0 95% CI, 2.5, 14.4). In multivariable analysis, the hypotension, mechanical ventilation, mental status, and cardiac arrest parameters of the PBS were independent risk factors for 14-day all-cause inpatient mortality. The temperature parameter as originally calculated for the PBS was not independently associated with mortality. However, a temperature < 36.0° C vs 36° C was independently associated with mortality. A qPitt score 2 had similar discrimination as a PBS 4 in nonbacteremia infections. Conclusions. Here, we validated that the PBS and qPitt score can be used as reliable predictors of mortality in nonbacteremia CRE infections.
AB - Background. Predicting mortality risk in patients is important in research settings. The Pitt bacteremia score (PBS) is commonly used as a predictor of early mortality risk in patients with bloodstream infections (BSIs). We determined whether the PBS predicts 14-day inpatient mortality in nonbacteremia carbapenem-resistant Enterobacteriaceae (CRE) infections. Methods. Patients were selected from the Consortium on Resistance Against Carbapenems in Klebsiella and Other Enterobacteriaceae, a prospective, multicenter, observational study. We estimated risk ratios to analyze the predictive ability of the PBS overall and each of its components individually. We analyzed each component of the PBS in the prediction of mortality, assessed the appropriate cutoff value for the dichotomized score, and compared the predictive ability of the qPitt score to that of the PBS. Results. In a cohort of 475 patients with CRE infections, a PBS 4 was associated with mortality in patients with nonbacteremia infections (risk ratio [RR], 21.9 95% confidence interval [CI], 7.0, 68.8) and with BSIs (RR, 6.0 95% CI, 2.5, 14.4). In multivariable analysis, the hypotension, mechanical ventilation, mental status, and cardiac arrest parameters of the PBS were independent risk factors for 14-day all-cause inpatient mortality. The temperature parameter as originally calculated for the PBS was not independently associated with mortality. However, a temperature < 36.0° C vs 36° C was independently associated with mortality. A qPitt score 2 had similar discrimination as a PBS 4 in nonbacteremia infections. Conclusions. Here, we validated that the PBS and qPitt score can be used as reliable predictors of mortality in nonbacteremia CRE infections.
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U2 - 10.1093/cid/ciz528
DO - 10.1093/cid/ciz528
M3 - Article
C2 - 31219148
AN - SCOPUS:85072842518
VL - 70
SP - 1826
EP - 1833
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 9
ER -