Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score

International Journal of Clinical Practice, vol. 74, pp. e13601

Abstract

OBJECTIVE: A cornerstone in the management of Staphylococcus aureus bacteraemia (SAB) is the differentiation between a complicated and an uncomplicated SAB course. The ability to early and accurately identify patients with - and without - complicated bacteraemia may optimise the utility of diagnostics and prevent unnecessary prolonged antibiotic therapy. METHODS: Development and validation of a prediction score in SAB using demographic, clinical, and laboratory data from two independent Dutch cohorts; estimating the risk of complicated disease at the time of the first positive blood culture. Models were developed using logistic regression and evaluated by c-statistics, ie area under the ROC-curve, and negative predictive values (NPV). RESULTS: The development- and validation cohorts included 150 and 183 patients, respectively. The most optimal prediction model included: mean arterial pressure, signs of metastatic infection on physical examination, leucocyte count, urea level and time to positivity of blood cultures (c-statistic 0.82, 95% CI 0.74-0.89). In the validation cohort, the c-statistic of the prediction score was 0,77 (95% CI 0.69-0.84). The NPV for complicated disease for patients with a score of ≤2 was 0.83 (95% CI 0.68-0.92), with a negative likelihood ratio of 0.14 (95% CI 0.06-0.31). CONCLUSION: The early SAB risk score helps to identify patients with high probability of uncomplicated SAB. However, the risk score's lacked absolute discriminative power to guide decisions on the management of all patients with SAB on its own. The heterogenicity of the disease and inconsistency in definitions of complicated SAB are important challenges in the development of clinical rules to guide the management of SAB.

Authors 10

1. Merel M. C. Lambregts corresponding Aachen Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands Department of Infectious Diseases

   Leiden University Medical Center

   Affiliation as printed

   Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands

   Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands

2. Eva B. D. Molendijk Aachen Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands Department of Internal Medicine Alrijne Hospital Leiderdorp The Netherlands Department of Infectious Diseases Department of Internal Medicine

   Leiden University Medical Center · Alrijne Ziekenhuis

   Affiliation as printed

   Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands

   Department of Internal Medicine Alrijne Hospital Leiderdorp The Netherlands

   Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands

   Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands

3. Soufian Meziyerh Aachen Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands Department of Infectious Diseases

   Leiden University Medical Center · Haga Hospital

   Affiliation as printed

   Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands

   Department of Internal Medicine Haga Teaching Hospital Den Haag The Netherlands

   Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands

   Department of Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands

4. Emile F. Schippers Aachen Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands Department of Infectious Diseases

   Leiden University Medical Center · Haga Hospital

   Affiliation as printed

   Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands

   Department of Internal Medicine Haga Teaching Hospital Den Haag The Netherlands

   Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands

   Department of Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands

5. Nathalie Manon Delfos Aachen Department of Internal Medicine Alrijne Hospital Leiderdorp The Netherlands Department of Internal Medicine

   Alrijne Ziekenhuis

   Affiliation as printed

   Department of Internal Medicine Alrijne Hospital Leiderdorp The Netherlands

   Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands

6. Masja Leendertse Aachen Department of Medical Microbiology Alrijne Hospital Leiderdorp The Netherlands Department of Medical Microbiology

   Alrijne Ziekenhuis

   Affiliation as printed

   Department of Medical Microbiology Alrijne Hospital Leiderdorp The Netherlands

   Department of Medical Microbiology, Alrijne Hospital, Leiderdorp, The Netherlands

7. Alexandra T. Bernards Aachen Department of Medical Microbiology Leiden University Medical Center Leiden The Netherlands Department of Medical Microbiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Microbiology Leiden University Medical Center Leiden The Netherlands

   Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands

8. Leo G. Visser Aachen Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands Department of Infectious Diseases

   Leiden University Medical Center

   Affiliation as printed

   Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands

   Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands

9. Olaf M. Dekkers Aachen Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands Department of Clinical Epidemiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

10. Mark G. J. de Boer Aachen Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands Department of Infectious Diseases

    Leiden University Medical Center

    Affiliation as printed

    Department of Infectious Diseases Leiden University Medical Center Leiden The Netherlands

    Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands