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Observational Study
. 2020 Apr 15;70(9):1826-1833.
doi: 10.1093/cid/ciz528.

The Pitt Bacteremia Score Predicts Mortality in Nonbacteremic Infections

Heather Henderson  1 , Courtney L Luterbach  2 , Eric Cober  3 , Sandra S Richter  4 , Robert A Salata  5 , Robert C Kalayjian  6 , Richard R Watkins  7   8 , Yohei Doi  9 , Keith S Kaye  10 , Scott Evans  11 , Vance G Fowler  12   13 , Robert A Bonomo  14   15   16   17 , Anthony Harris  18 , Sonia Napravnik  1 , David Van Duin  1
Affiliations
Observational Study

The Pitt Bacteremia Score Predicts Mortality in Nonbacteremic Infections

Heather Henderson et al. Clin Infect Dis. .

Abstract

Background: Predicting mortality risk in patients is important in research settings. The Pitt bacteremia score (PBS) is commonly used as a predictor of early mortality risk in patients with bloodstream infections (BSIs). We determined whether the PBS predicts 14-day inpatient mortality in nonbacteremia carbapenem-resistant Enterobacteriaceae (CRE) infections.

Methods: Patients were selected from the Consortium on Resistance Against Carbapenems in Klebsiella and Other Enterobacteriaceae, a prospective, multicenter, observational study. We estimated risk ratios to analyze the predictive ability of the PBS overall and each of its components individually. We analyzed each component of the PBS in the prediction of mortality, assessed the appropriate cutoff value for the dichotomized score, and compared the predictive ability of the qPitt score to that of the PBS.

Results: In a cohort of 475 patients with CRE infections, a PBS ≥4 was associated with mortality in patients with nonbacteremia infections (risk ratio [RR], 21.9; 95% confidence interval [CI], 7.0, 68.8) and with BSIs (RR, 6.0; 95% CI, 2.5, 14.4). In multivariable analysis, the hypotension, mechanical ventilation, mental status, and cardiac arrest parameters of the PBS were independent risk factors for 14-day all-cause inpatient mortality. The temperature parameter as originally calculated for the PBS was not independently associated with mortality. However, a temperature <36.0°C vs ≥36°C was independently associated with mortality. A qPitt score ≥2 had similar discrimination as a PBS ≥4 in nonbacteremia infections.

Conclusions: Here, we validated that the PBS and qPitt score can be used as reliable predictors of mortality in nonbacteremia CRE infections.

Keywords: Klebsiella pneumoniae; Carbapenem-resistant Enterobacteriaceae; Pitt bacteremia score; mortality; risk score.

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Figures

Figure 1.
Figure 1.
Selection of culture episodes.
Figure 2.
Figure 2.
Observed mortality by Pitt bacteremia score for carbapenem-resistant Enterobacteriaceae bacteremia and nonbacteremia infections. Scores ≥7 combined into a single category.
Figure 3.
Figure 3.
Survival curves for Pitt bacteremia score ≥4 vs <4. Abbreviation: PBS, Pitt bacteremia score.
See this image and copyright information in PMC

Comment in

References

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