Diagnostic performance of food consumption for bacteraemia in patients admitted with suspected infection: a prospective cohort study

Abstract

ObjectivesA previous study reported that food consumption is useful to rule out bacteraemia in hospitalised patients. We aimed to validate the diagnostic performance of (1) food consumption and (2) a previously reported algorithm using food consumption and shaking chills for bacteraemia in patients admitted to hospital with suspected infection.DesignProspective cohort study.SettingDepartment of General Medicine in two acute care hospitals in Japan.ParticipantsA total of 2009 adult patients who underwent at least two blood cultures on admission.Primary outcome measuresThe reference standard for bacteraemia was judgement by two independent specialists of infectious diseases. Food consumption was evaluated by the physician in charge asking the patient or their caregivers the following question on admission: ‘What percentage of usual food intake were you able to eat during the past 24 hours?’ResultsAmong 2009 patients, 326 patients were diagnosed with bacteraemia (16.2%). Diagnostic performance of food consumption was sensitivity of 84.4% (95% CI 80.1 to 88), specificity of 19.8% (95% CI 18 to 21.8), positive predictive value (PPV) of 16.9% (95% CI 15.2 to 18.9) and negative predictive value (NPV) of 86.8% (95% CI 83.1 to 89.8). The discriminative performance was an area under the curve of 0.53 (95% CI 0.50 to 0.56). The performance of the algorithm using food consumption and shaking chills was sensitivity of 89% (95% CI 85.1 to 91.9), specificity of 18.8% (95% CI 17 to 20.7), PPV of 17.5% (95% CI 15.7 to 19.4) and NPV of 89.8% (95% CI 86.2 to 92.5).ConclusionOur results did not show the usefulness of food consumption and the algorithm using food consumption and shaking chills for the diagnosis of bacteraemia in patients admitted to hospital with suspected infection.

Added value of Eastern Cooperative Oncology Group-Performance Status to Quick Sequential Organ Failure Assessment for predicting 30-day mortality in older patients admitted with suspected infections

“…First, the inclusion criterion that blood cultures should be examined relies on decisions made by the physicians, which might be considered subjective and could compromise the reproducibility of this study. Nonetheless, this inclusion criterion has been conventionally used in previous studies because it is unethical to perform blood culture examinations for all patients [13][14][15][16][17][18]. Second, while the ECOG-PS score has been found to be a useful predictor of prognosis, it is still unclear whether intervention strategies, such as early initiation of treatment for patients with a poor prognosis, can effectively improve their clinical outcomes.…”

“…Between January 2018 and January 2019, we consecutively enrolled patients aged 65 years or older, who were admitted with suspected infections. A patient with suspected infections was de ned as a patient who had at least two sets of blood culture examinations performed within 24 hours of admission to the Department of General Medicine [13][14][15][16][17][18]. The patients' medical care providers decided to obtain the blood samples at their discretion.…”

Added value of ECOG-Performance Status to qSOFA for predicting 30-day mortality in older patients admitted with suspected infections

“…First, the inclusion criterion that blood cultures should be examined relies on decisions made by the physicians, which might be considered subjective and could compromise the reproducibility of this study. Nonetheless, this inclusion criterion has been conventionally used in previous studies because it is unethical to perform blood culture examinations for all patients [27][28][29][30][31][32] . Second, while the ECOG-PS score is a useful predictor of prognosis, it is still unclear whether intervention strategies, such as early initiation of treatment for patients with a poor prognosis, can effectively improve their clinical outcomes.…”

“…Between January 2018 and January 2019, we consecutively enrolled patients aged 65 years or older, who were admitted with suspected infections. A patient with suspected infections was de ned as a patient who had at least two sets of blood culture examinations performed within 24 hours of admission to the Department of General Medicine [27][28][29][30][31][32] . The patients' medical care providers decided to obtain the blood samples at their discretion.…”

Supplementary Contribution of Eastern Cooperative Oncology Group-Performance Status to Quick Sequential Organ Failure Assessment in the Detection of Bacteremia Among Older Patients With Suspected Infections

“…We consecutively enrolled patients aged ≥65 years, admitted with a suspected infection of bacteremia between January 2018 and 2019. A patient displaying signs of infection underwent a minimum of two sets of blood culture examinations within initial 24 hours of being admitted to the Department of General Medicine [19][20][21][22][23][24]. The decision to collect blood samples was left to the discretion of patients' healthcare providers.…”