The difference between the Apache II score at the onset of Staphylococcus aureus bacteremia and the Apache II score of the day before is considered to be the result of the intervening bacteremia and corrects for any prebacteremic conditions in the patient. Since the length and nature of therapy with antibiotics is largely determined by the presence or absence of metastatic abscesses with pursuant complications, the ability to determine the likely outcome can help in determining the initial management of the patient.
delta-Apache II score =
= (Apache II score on the day of 1st positive blood culture) - (Apache II score on day before)
where:
• Apache II scores range from 0-71, with higher numbers indicating a higher risk of death
Interpretation:
• uncomplicated cases: no signs of septic shock and no evidence of metastatic abscess
• complicated: septic shock at the onset of bacteremia, or the presence of metastatic abscesses later in the disease course
delta score
uncomplicated
complicated but nonfatal
complicated and fatal
<=3
95%
0
5%
4-6
91%
3%
6%
7-9
25%
31%
44%
>=10
0%
13%
87%
Management:
(1) uncomplicated cases of bacteremia: may often be treated with a 2 week course with antistaphylococcal antibiotics after removal of an identified primary focus of infection
(2) complicated cases of bacteremia with metastatic abscesses: require 4-6 or more weeks of intravenous therapy with high dose antistaphylococcal antibiotics
Limitations:
• Data is based only on nosocomial infections. Community-acquired infections may have different outcomes.
• The influence of antibiotic resistant strains is not included.
To read more or access our algorithms and calculators, please log in or register.
