Bacteraemia prediction in emergency medical admissions: role of C reactive protein

Abstract

Aim: To define the contribution made by C reactive protein (CRP) measurement to bacteraemia prediction in adults with medical emergencies in the UK. Methods: This two year cohort study involved 6234 patients admitted as emergency cases to the acute medical or infectious diseases services of the Oxford Radcliffe Hospitals, in whom blood cultures were taken on arrival. The main outcome measures were bacteraemia risk associated with admission CRP concentrations, lymphocyte counts, and neutrophil counts. Results: The quantitative associations between CRP concentration, admission lymphocyte count, and neutrophil count were defined. Risk of bacteraemia rose continuously as the CRP increased: no ''cutoff'' value was evident. Models examining combinations of CRP, neutrophil count, and lymphocyte count were developed and validated using a split sample technique. CRP contributed to a model including lymphocyte and neutrophil counts, but its effect was small. CRP alone performed no better than either a model combining lymphopenia and neutrophilia, or than lymphopenia alone. Conclusions: In patients with acute medical emergencies who are suspected of bacteraemia clinically, CRP concentrations, although associated with bacteraemia, have a limited role in bacteraemia prediction.

Is MRSA admission bacteraemia community-acquired? A case control study

“…22,23 These results support previous anonymised analyses in the same population demonstrating that the population at highest risk of admission MRSA bacteraemia are those with previous hospital contact. Notably, among these patients, MRSA bacteraemia occurred at rates comparable with Streptococcus pneumoniae, MSSA and Escherichia coli bacteraemia.…”

Updated Review of Blood Culture Contamination

“…For a prediction model to be maximally useful, it should be applicable to other settings (148). Researchers have developed or studied models for predicting bacteremia in hospitalized adults (12,65,72,80,85,88,160) and adult patients seen in emergency departments (40,120,159). Similar efforts have been explored in pediatric populations, although the motivation for many of these models is targeted primarily at decisionmaking regarding hospital admission versus outpatient management and initiation of empirical therapy and not whether or not to obtain blood cultures (3,4,8,61,70,99).…”

“…Bacteremia prediction modeling in the emergency department setting has been studied as well (40,120,159). Shapiro et al described a general clinical prediction rule for bacteremia in the emergency department setting that identified low-risk groups that were associated with a 0.8% and 1.8% risk of bacteremia (derivation and validation populations, respectively) (120).…”

Relationship of neutrophil-to-lymphocyte ratio with presence and severity of pneumonia

“…Goodman et al suggested that NLR was beneficial in the diagnosis of patients with suspected appendicitis, and more sensitive in showing bacterial infection than WBC [23]. Also, NLR was studied as an infection marker in patients in intensive care units and it was found to correlate well with disease severity and outcome [24][25][26]. Zahorec et al reported correlation between the severity of the clinical course and the grade of neutrophilia and lymphocytopenia in patients with severe sepsis and septic shock in an oncologic intensive care unit.…”