Paradoxical outcomes of gram‐negative bloodstream infection in solid organ transplant recipients

Battle, Sarah; Al-Hasan, Majdi N.

doi:10.1111/tid.13964

Cited by 1 publication

(1 citation statement)

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“… 35 Not coincidentally, it has been reported that those who had sepsis and septic shock with an immunocompromised status did not have a higher mortality rate than non-immunocompromised patients. 36 Battle and Al-Hasan 37 thought that immunocompromised patients would more easily capture the clinicians’ attention and receive aggressive empirical antimicrobial treatments, which could be a plausible explanation for this phenomenon. This paradox may also be related to immunosuppression, which could inhibit the development of the sepsis cascade by lowering the pro-inflammatory chemokine and cytokine responses.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury should not be neglected – optimization of quick Pitt bacteremia score for predicting mortality in critically ill patients with bloodstream infection: a retrospective cohort study

Cai,

Yang,

Deng

et al. 2024

Therapeutic Advances in Infection

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Background: Considering the therapeutic difficulties and mortality associated with bloodstream infection (BSI), it is essential to investigate other potential factors affecting mortality in critically ill patients with BSI and examine the utility of the quick Pitt bacteremia (qPitt) score to improve the survival rate. Objectives: To improve the predictive accuracy of the qPitt scoring system by evaluating the five current components of qPitt and including other potential factors influencing mortality in critically ill patients with BSI. Design: This was a retrospective cohort study. Methods: Medical information from the Medical Information Mart for Intensive Care IV database was used in this retrospective cohort study. The risk factors associated with mortality were examined using a multivariate logistic regression model. The area under the receiver operating characteristic curve (AUC) was used to assess the discriminatory capability of the prediction models. Results: In total, 1240 eligible critically ill patients with BSI were included. After adjustment for age, community-onset BSI, indwelling invasive lines, and Glasgow Coma Scale (GCS) ⩽ 8, acute kidney injury (AKI) was identified as a notable risk factor for 14-day mortality. Except for altered mental status, the four other main components of the original qPitt were significantly associated with 14-day mortality. Hence, we established a modified qPitt (m-qPitt) by adding AKI and replacing altered mental status with GCS ⩽ 8. The AUCs for m-qPitt and qPitt were 0.723 [95% confidence interval (CI): 0.683–0.759] and 0.708 (95% CI: 0.669–0.745) in predicting 14-day mortality, respectively. Moreover, m-qPitt also had acceptable performance and discrimination power [0.700 (95% CI: 0.666–0.732)] in predicting 28-day mortality. Conclusion: AKI significantly influenced the survival of critically ill patients with BSIs. Compared with the original qPitt, our new m-qPitt was proven to have a better predictive performance for mortality in critically ill patients with BSI. Further studies should be conducted to validate the practicality of m-qPitt.

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Section: Discussionmentioning

confidence: 99%