Huang et al reported scores for predicting bloodstream infection (BSI) in a patient with a complicated intra-abdominal infection. The authors are from Jinling Hospital, University Medical Center of Hamburg-Eppendorf, Southeast University (Nanjing) and Maastricht University.
Patient selection: complicated intra-abdominal infection
Outcomes:
(1) secondary BSI: >= 1 organism isolated from blood that matches an organism isolated from the complicated intra-abdominal infection, OR an organism isolated from blood that is used to meet the NHSN site-specific infection criterion
(2) non-secondary BSI: BSI excluding CLABSI and excluding secondary
Parameters:
(1) serum ALT in U/L (LLN 13; ULN 66)
(2) failure to respond to initial empiric antibiotics
(3) SOFA score
(4) serum procalcitonin (ULN 0.045 mcg/L)
(5) generalized peritonitis
|
Parameter
|
Finding
|
Points
|
|
ALT
|
< 66 U/L
|
0
|
|
|
>= 66
|
2
|
|
failure to respond
|
yes
|
3
|
|
|
no (responded)
|
0
|
|
SOFA
|
0 or 1
|
0
|
|
|
>= 2
|
3
|
|
generalized peritonitis
|
no
|
0
|
|
|
yes
|
4
|
where:
• A score at the upper limit of normal is considered positive.
score for bloodstream infection =
= SUM(points for all of the parameters)
|
Parameter
|
Finding
|
Points
|
|
failure to respond
|
yes
|
3
|
|
|
no (responded)
|
0
|
|
SOFA
|
0 or 1
|
0
|
|
|
>= 2
|
5
|
|
generalized peritonitis
|
no
|
0
|
|
|
yes
|
8
|
score for secondary bloodstream infection =
= SUM(points for all of the parameters)
|
Parameter
|
Finding
|
Points
|
|
failure to respond
|
yes
|
3
|
|
|
no (responded)
|
0
|
|
SOFA
|
0 or 1
|
0
|
|
|
>= 2
|
3
|
|
procalcitonin
|
< 0.43 mcg/L
|
0
|
|
|
>= 0.43 mcg/L
|
3
|
score for non-secondary bloodstream infection =
= SUM(points for all of the parameters)
Interpretation:
• minimum scores: 0
• maximum BSI score: 12
• maximum secondary BSI score: 16
• maximum non-secondary BSI score: 9
|
Score
|
Predictive
|
Area Under ROC Curve
|
|
BSI
|
>= 5
|
0.81
|
|
secondary BSI
|
>= 9
|
0.86
|
|
non-secondary BSI
|
>= 6
|
0.75
|
