Models for Assessing Severity of Illness in Patients with Bloodstream Infection: a Narrative Review

2021 ◽  
Author(s):  
Joseph M. Mylotte
Keyword(s):  
Bloodstream Infection ◽  
Severity Of Illness ◽  
Narrative Review

Impact of multiple concurrent central lines on central-line–associated bloodstream infection rates

2019 ◽  
Vol 40 (9) ◽  
pp. 1019-1023 ◽  
Author(s):  
Jesse Couk ◽  
Sheri Chernetsky Tejedor ◽  
James P. Steinberg ◽  
Chad Robichaux ◽  
Jesse T. Jacob
Keyword(s):  
Bloodstream Infection ◽  
Hospital Admissions ◽  
Pay For Performance ◽  
Descriptive Analysis ◽  
Cohort Analysis ◽  
Severity Of Illness ◽  
Central Line ◽  
Central Lines ◽  
Academic Medical ◽  
Retrospective Cohort Analysis

AbstractBackground:The current methodology for calculating central-line–associated bloodstream infection (CLABSI) rates, used for pay-for-performance measures, does not account for multiple concurrent central lines.Objective:To compare CLABSI rates using standard National Healthcare Safety Network (NHSN) denominators to rates accounting for multiple concurrent central lines.Design:Descriptive analysis and retrospective cohort analysis.Methods:We identified all adult patients with central lines at 2 academic medical centers over an 18-month period. CLABSI rates were calculated for intensive care units (ICUs) and non-ICUs using the standard NHSN methodology and denominator (a patient could only have 1 central-line day for a given patient day) and a modified denominator (number of central lines in 1 patient in 1 day count as number of line days). We also compared characteristics of patients with and without multiple concurrent central lines.Results:Among 18,521 hospital admissions, there were 156,574 central-line days and 239 CLABSIs (ICU, 105; non-ICU, 134). Our modified denominator reduced CLABSI rates by 25% in ICUs (1.95 vs 1.47 per 1,000 line days) and 6% (1.30 vs 1.22 per 1,000 line days) in non-ICUs. Patients with multiple concurrent central lines were more likely to be in an ICU, to have a longer admission, to have a dialysis catheter, and to have a CLABSI.Conclusions:Using the number of central lines as the denominator decreased CLABSI rates in ICUs by 25%. The presence of multiple concurrent central lines may be a marker of severity of illness. The risk of CLABSI per lumen of a central line is similar in ICUs compared to wards.

scholarly journals Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico

2010 ◽  
Vol 31 (11) ◽  
pp. 1106-1114 ◽  
Author(s):  
Adrian G. Barnett ◽  
Nicholas Graves ◽  
Victor D. Rosenthal ◽  
Reinaldo Salomao ◽  
Manuel Sigfrido Rangel-Frausto
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infection ◽  
Latin American ◽  
Severity Of Illness ◽  
Central Line ◽  
Risk Of Death ◽  
Time Period ◽  
Increased Risk ◽  
Latin American Countries

Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.

Association Between Mucositis Severity and Vancomycin-Resistant Enterococcal Bloodstream Infection in Hospitalized Cancer Patients

1999 ◽  
Vol 20 (10) ◽  
pp. 660-663 ◽  
Author(s):  
Matthew J. Kuehnert ◽  
John A. Jernigan ◽  
Amy L. Pullen ◽  
David Rimland ◽  
William R. Jarvis
Keyword(s):  
Cancer Patients ◽  
Bloodstream Infection ◽  
Medical Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Vancomycin Resistant ◽  
Increasing Risk ◽  
Oncology Unit

AbstractObjective:To determine the role of mucositis severity in the development of vancomycin-resistant enterococcal (VRE) bloodstream infection (BSI).Setting:A tertiary-care university medical center.Participants:Hematology-oncology-unit inpatients.Design:Patients with VRE BSI (case-patients) were compared with VRE-colonized (control) patients from September 1994 through August 1997. Oral mucositis severity was recorded on the day of VRE BSI for case-patients and on hospital day 22 (median day of hospitalization of case-patient VRE BSI) for controls. There were 19 case-patients and 31 controls.Results:In univariate analysis, case-patients were significantly more likely than controls to have a higher mucositis severity score, diarrhea, or a higher severity of illness score. In multivariate analysis, only mucositis remained as an independent risk factor, and increasing mucositis score was significantly associated with VRE BSI.Conclusions:Mucositis severity was independently associated with an increasing risk for VRE BSI. Interventions to alter mucositis severity may help to prevent VRE BSI in hospitalized cancer patients.

Impact of Switching from an Open to a Closed Infusion System on Rates of Central Line–Associated Bloodstream Infection: A Meta-analysis of Time-Sequence Cohort Studies in 4 Countries

2011 ◽  
Vol 32 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Dennis G. Maki ◽  
Victor D. Rosenthal ◽  
Reinaldo Salomao ◽  
Fabio Franzetti ◽  
Manuel Sigfrido Rangel-Frausto
Keyword(s):  
Cohort Studies ◽  
Bloodstream Infection ◽  
Meta Analysis ◽  
Severity Of Illness ◽  
Central Line ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Icu Mortality ◽  
Increased Risk ◽  
The Impact

Background.We report a meta-analysis of 4 identical time-series cohort studies of the impact of switching from use of open infusion containers (glass bottle, burette, or semirigid plastic bottle) to closed infusion containers (fully collapsible plastic containers) on central line-associated bloodstream infection (CLABSI) rates and all-cause intensive care unit (ICU) mortality in 15 adult ICUs in Argentina, Brazil, Italy, and Mexico.Methods.All ICUs used open infusion containers for 6–12 months, followed by switching to closed containers. Patient characteristics, adherence to infection control practices, CLABSI rates, and ICU mortality during the 2 periods were compared by χ2test for each country, and the results were combined using meta-analysis.Results.Similar numbers of patients participated in 2 periods (2,237 and 2,136). Patients in each period had comparable Average Severity of Illness Scores, risk factors for CLABSI, hand hygiene adherence, central line care, and mean duration of central line placement. CLABSI incidence dropped markedly in all 4 countries after switching from an open to a closed infusion container (pooled results, from 10.1 to 3.3 CLABSIs per 1,000 central line-days; relative risk [RR], 0.33 [95% confidence interval {CI}, 0.24-0.46];P<.001). All-cause ICU mortality also decreased significantiy, from 22.0 to 16.9 deaths per 100 patients (RR, 0.77 [95% CI, 0.68-0.87];P<.001).Conclusions.Switching from an open to a closed infusion container resulted in a striking reduction in the overall CLABSI incidence and all-cause ICU mortality. Data suggest that open infusion containers are associated with a greatiy increased risk of infusion-related bloodstream infection and increased ICU mortality that have been unrecognized. Furthermore, data suggest CLABSIs are associated with significant attributable mortality.

scholarly journals 851. Validation of Quick Pitt Bacteremia Score in Patients with Staphylococcus aureus Bloodstream Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S17-S17
Author(s):  
Sarah Elizabeth. Battle ◽  
Julie Ann Justo ◽  
P Brandon Bookstaver ◽  
Joseph Kohn ◽  
Majdi Al-hasan
Keyword(s):  
Staphylococcus Aureus ◽  
South Carolina ◽  
Bloodstream Infection ◽  
Characteristic Curve ◽  
Severity Of Illness ◽  
Fold Increase ◽  
Microbiological Characteristics ◽  
Point Increase ◽  
High Discrimination ◽  
Mortality Table

Abstract Background A quick version of the Pitt Bacteremia Score (qPitt) was recently derived based on five binary variables each assigned one point (Table 1). The qPitt broadened respiratory failure definition, simplified mental status, and eliminated fever from the original Pitt bacteremia score. The qPitt had high discrimination in predicting mortality in patients with Gram-negative bloodstream infection (BSI) and outperformed other acute severity of illness scores. This retrospective cohort study aims to evaluate the qPitt performance in patients with Staphylococcus aureus BSI and compare its discrimination to quick Sepsis Related Organ Failure Assessment (qSOFA). Methods Hospitalized adult patients with S. aureus BSI at Prisma Health-Midlands hospitals in South Carolina from January 1, 2015 to December 31, 2017 were identified. Multivariate logistic regression was used to examine risk factors for 28-day all-cause mortality. The area under receiver operating characteristic curve (AUROC) was used to evaluate discrimination of qPitt and qSOFA in predicting 28-day mortality (primary outcome). In-hospital and 90-day mortality were examined as secondary outcomes. Results Among the 398 patients with S. aureus BSI, the median age was 63 years, 241 (61%) were men, 173 (43%) had methicillin-resistant S. aureus (MRSA) BSI, and 95 (24%) died within 28 days of BSI. After adjustments for age, clinical and microbiological characteristics in the multivariate model, all five individual components of qPitt were independently associated with 28-day mortality (Table 1). There was a 3-fold increase in 28-day mortality for each point increase in qPitt (odds ratio 3.11, 95% confidence intervals: 2.40–4.02, P < 0.001). Mortality was 2% in patients with qPitt of 0 and increased to 14%, 24%, 50%, and 82% in patients with qPitt of 1, 2, 3, and ≥4, respectively. The qPitt had higher discrimination in predicting 28-day mortality than qSOFA (AUROC 0.82 vs. 0.77, P = 0.001). The qPitt also performed well in predicting in-hospital and 90-day mortality (AUROC 0.80 and 0.76, respectively). Conclusion The qPitt has good discrimination in predicting mortality in patients with S. aureus BSI. These results support using the qPitt as an acute severity of illness score in future studies. Disclosures All Authors: No reported Disclosures.

scholarly journals Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico

2010 ◽  
Vol 31 (11) ◽  
pp. 1106-1114 ◽  
Author(s):  
Adrian G. Barnett ◽  
Nicholas Graves ◽  
Victor D. Rosenthal ◽  
Reinaldo Salomao ◽  
Manuel Sigfrido Rangel-Frausto
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infection ◽  
Latin American ◽  
Severity Of Illness ◽  
Central Line ◽  
Risk Of Death ◽  
Time Period ◽  
Increased Risk ◽  
Latin American Countries

Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.

Intensity of Vascular Catheter Use in Critical Care: Impact on Catheter-Associated Bloodstream Infection Rates and Association with Severity of Illness

2012 ◽  
Vol 33 (12) ◽  
pp. 1268-1270 ◽  
Author(s):  
Kimberlee S. Fong ◽  
Mary Banks ◽  
Rebekah Benish ◽  
Cynthia Fatica ◽  
Melissa Triche ◽  
...  
Keyword(s):  
Critical Care ◽  
Bloodstream Infection ◽  
Severity Of Illness ◽  
Infection Rates

Abstract #255: Glimepiride – Bench to Bedside: Narrative Review of the Technological Advancement Update

2017 ◽  
Vol 23 ◽  
pp. 60
Author(s):  
Altamash Shaikh ◽  
Anuj Maheshwari ◽  
Banshi Saboo ◽  
Ashok Jhingan ◽  
Shriram Kulkarni ◽  
...  
Keyword(s):  
Narrative Review ◽  
Technological Advancement
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