Fowler et al developed a clinical score which can help identify patients with complicated Staphylococcus aureus bacteremia. These patients may benefit from a more aggressive diagnostic workup and management. The authors are from Duke University and the Durham VA Medical Center.
Complicated bacteremia includes:
(1) infective endocarditis
(2) vertebral osteomyelitis
(3) epidural abscess
(4) septic thrombophlebitis
(5) psoas or other deep tissue abscess
(6) meningitis
(7) septic arthritis
(8) recurrent infection
(9) embolic stroke
(10) death
Parameters:
(1) positive follow-up blood culture at 48-96 hours after the initial culture was reported positive (and presumably after starting therapy)
(2) site of presumed acquisition
(3) skin examination findings suggesting acute systemic infection (petechiae, vasculitis, infarcts, ecchymoses, pustules)
(4) persistent fever at 72 hours
|
Parameter |
Finding |
Points |
|
positive blood cultures at 48-96 hours |
yes |
2 |
|
|
no |
0 |
|
acquisition |
community |
1 |
|
|
nosocomial |
0 |
|
skin examination findings |
present |
1 |
|
|
absent |
0 |
|
persistent fever at 72 hours |
yes |
1 |
|
|
no |
0 |
where:
• Community acquired infections were those that occurred within 72 hours of hospital admission in a patient without extensive health care contact.
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the more likely the bacteremia has complications.
|
Total Score |
Probability of Complications |
|
0 |
16% |
|
1 |
25-35% |
|
2 |
33-53% |
|
3 |
69% |
|
4 |
82% |
|
5 |
95% |
from Figure 2, page 2070
Purpose: To identify a patient with complicated Staphylococcus aureus bacteremia using the clinical score of Fowler et al.
Specialty: Infectious Diseases
Objective: criteria for diagnosis, severity, prognosis, stage
ICD-10: A49.0, A49.9,
