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- Title
Evaluation of early clinical failure criteria in Enterococcus species bloodstream infection.
- Authors
Powers, Caroline E.; Bookstaver, P. Brandon; Caulder, Celeste; Bouknight, Abigail; Justo, Julie Ann; Kohn, Joseph; Winders, Hana Rac; Al-Hasan, Majdi N.
- Abstract
Purpose: Early clinical failure criteria (ECFC) were recently introduced to predict unfavorable outcomes in patients with Gram-negative bloodstream infections (BSI). ECFC include hypotension, tachycardia, tachypnea or mechanical ventilation, altered mental status, and leukocytosis evaluated at 72–96 h after BSI. The aim of this retrospective cohort study was to assess performance of ECFC in predicting 28-day mortality in Enterococcus species BSI. Methods: Hospitalized adults with Enterococcus species BSI at Prisma Health hospitals from 1 January 2015 to 31 July 2018 were identified. Multivariate logistic regression was used to determine the association between ECFC and 28-day mortality. Area under the receiver operating characteristic (AUROC) curve was used to measure model discrimination. Results: Among 157 patients, 28 (18%) died within 28 days of BSI. After adjustments in multivariate model, the risk of 28-day mortality increased in the presence of each additional ECFC (OR 1.6, 95% CI 1.2–2.3, p = 0.005). Infective endocarditis (OR 3.9, 95% CI 1.4–10.7, p = 0.01) was independently associated with 28-day mortality. AUROC curve of ECFC model in predicting 28-day mortality was 0.74 with ECFC of 2 identified as the best breakpoint. Mortality was 8% in patients with ECFC < 2 compared to 33% in those with ECFC ≥ 2 (p < 0.001). Conclusion: ECFC had good discrimination in predicting 28-day mortality in patients with Enterococcus species BSI. These criteria may have utility in future clinical investigations.
- Subjects
CATHETER-related infections; CONFIDENCE intervals; MULTIVARIATE analysis; RETROSPECTIVE studies; TREATMENT effectiveness; INFECTIVE endocarditis; ENTEROCOCCUS; GRAM-negative bacterial diseases; LOGISTIC regression analysis; RECEIVER operating characteristic curves; ODDS ratio; PREDICTION models; DATA analysis software; BLOODBORNE infections; LONGITUDINAL method; DISEASE complications
- Publication
Infection, 2022, Vol 50, Issue 4, p873
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-022-01754-6