A Novel Prediction Model for Bloodstream Infections in Hepatobiliary–Pancreatic Surgery Patients

Abstract

Background Bloodstream infections (BSI) are an important source of postoperative mortality in hepatobiliarypancreatic surgery (HBPS) patients, and no prediction model has been analyzed before. Methods Using big data from the electronic medical records of the administrative and culture databases of MacKay Memorial Hospital, we identified the potential risk factors for community-acquired and healthcare-associated BSI and mortality of patients who received HBPS. Subsequently, we analyzed the microorganisms' profiles and antimicrobial susceptibility patterns for these BSI. Results BSI were found in 6.3% patients (349 of 5513 HBPS patients), and hospital mortality was 1.48% (82 of 5513). Dividing patients into low-, intermediate-, and high-risk groups on the basis of sex, age, status of comorbidity (renal failure, peptic ulcer disease, fluid and electrolyte disorders, and acute cholecystitis), a predictive BSI risk score model was developed. According to this model, BSI risk ranged from 1.43% to 11.95%; AUROC to predict BSI risk was 0.72 (95% CI 0.69-0.75). From this retrospective study, Enterobacteriaceae were the most common microorganisms that were isolated from BSI. For both community-acquired and healthcare-associated BSI, imipenem and colistin are the most successful. Conclusion This novel model can be useful to predict who is at risk of BSI after HBPS, and new prophylactic protocols for these patients are needed.

Clinical impact of bloodstream infection on acute cholecystitis indicated for emergency cholecystectomy

“…coli and K . pneumoniae ) as the most commonly isolated bacteria from blood culture 18 . A report revealed that obese or overweight patients with acute calculous cholecystitis were less likely to develop BSI 7 .…”

“…The elderly have not been included as a severity parameter in the TG18 10 . Older age is an important risk factor for bacteria 13,15,18 . The febrile response to infection is decreased in elderly patients 9 .…”

“…10 Older age is an important risk factor for bacteria. 13,15,18 The febrile response to infection is decreased in elderly patients. 9 Caution should be taken because age-related decline in renal function and multiple oral medications for treatment of coexisting disease may adversely affect the action of antibiotics.…”

“…Gender, renal failure, peptic ulcer disease, fluid and electrolyte disorders, acute cholecystitis, and age of >65 years have been reported as risk factors for BSI in patients who underwent hepatobiliary-pancreatic surgery, with Enterobacteriaceae (especially E. coli and K. pneumoniae) as the most commonly isolated bacteria from blood culture. 18 A report revealed that obese or overweight patients with acute calculous cholecystitis were less likely to develop BSI. 7 The results of this study show that lower BMI, not diabetes was associated with BSI.…”

Predicting bacteraemia in maternity patients using full blood count parameters: A supervised machine learning algorithm approach

“…An algorithm can then be constructed to determine how best to discriminate between the two groups. Prediction models for bacteraemia have been devised but very few focus exclusively on pregnant and post‐partum women 21‐29 …”