### Description

The presence of certain clinical findings can help predict bacteremia or fungemia in critical care patients with the Sepsis Syndrome. Since most patients with the Sepsis Syndrome do not have bloodstream infections, this can help separate patients according to their risk for bloodstream infection.

NOTE: The Sepsis Syndrome is described in the chapter on Critical Care.

Method:

(1) The variables associated with disease state are identified by logistic regression analysis.

(2) Points are assigned by dividing the beta coefficient by an appropriate denominator to yield an integer score.

(3) Since a model for Gram-positive bacteremia did not perform well, the model for Staphylococcus aureus was developed.

Any Bacteremia

Variable

Beta Coefficient

Odds Ratio

Points

intercept

-2.03

suspected or documented focal infection at onset

0.86

2.4

3

no antibiotics before onset

0.84

2.4

3

any liver disease

0.59

1.8

2

Hickman catheter present

0.57

1.8

2

altered mental status within 24 hours

0.61

1.8

2

focal abdominal signs within 24 hours

0.49

1.6

2

where:

• any liver disease = cirrhosis with or without portal hypertension, chronic hepatitis within last 6 months, hepatic failure with coma or encephalopathy within last 6 months

risk score for any bacteremia =

= SUM(points for variables present)

Interpretation:

• minimum score: 0

• maximum score: 14

Risk Score

Percent with Bacteremia

0

14.5%

1-2

18.5%

3-4

20.5%

5-6

38%

>= 7

60.6%

Staphylococcus Aureus Bacteremia

Variable

Beta Coefficient

Odds Ratio

Points

intercept

-3.62

suspected or documented focal infection with S. aureus at onset

1.89

6.6

2

hemodialysis before onset

1.09

3.0

1

ventilator use before onset

0.79

2.2

1

risk score for S. aureus bacteremia =

= SUM(points for variables present)

Interpretation:

• minimum score: 0

• maximum score: 4

Risk Score

Percent with S. aureus Bacteremia

0

2.6%

1

4.8%

2

18.9%

>= 3

21%

Any Gram-negative Rod Bacteremia

Variable

Beta Coefficient

Odds Ratio

Points

intercept

-3.1

total parenteral nutrition before onset

1.57

4.8

3

no antibiotics before onset

1.30

3.7

2

history of Gram-negative bacteremia

1.15

3.2

2

Hickman catheter present

0.72

2.1

1

focal abdominal signs within 24 hours

0.63

1.9

1

chills

0.51

1.7

1

risk score for Gram-negative bacteremia =

= SUM(points for variables present)

Interpretation:

• minimum score: 0

• maximum score: 10

Risk Score

Percent with Gram-negative Bacteremia

0

5.3%

1

6.2%

2

12.8%

3

20.3%

>= 4

41.9%

Any Fungemia

Variable

Beta Coefficient

Odds ratio

Points

intercept

-5.27

fungal infection at any site

2.32

10.1

5

bowel perforation

1.58

4.9

3

pyuria

1.27

3.6

2

any liver disease

1.16

3.2

2

Hickman catheter present

1.10

3.0

2

altered mental status within 24 hours

0.99

2.7

2

risk score for any fungemia =

= SUM(points for variables present)

Interpretation:

• minimum score: 0

• maximum score: 16

Risk Score

Percent with Fungemia

0

0.6%

1-3

1.3%

4-6

5.1%

>= 7

26.1%

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