The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

Abstract

Many patients with leptospirosis, melioidosis, and rickettsial infection require intensive care unit (ICU) admission in tropical Australia every year. The multi-organ dysfunction associated with these infections results in significantly elevated severity of illness (SOI) scores. However, the accuracy of these SOI scores in predicting death from these tropical infections is incompletely defined. This retrospective study was performed at Cairns Hospital, a tertiary-referral hospital in tropical Australia. All patients admitted to ICU with laboratory-confirmed leptospirosis, melioidosis, and rickettsial disease between January 1, 1999 and June 30, 2020, were eligible for the study. The ability of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Scores (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores to predict death before ICU discharge was evaluated. Overall, 18 (12.1%) of the 149 included patients died: 15/74 (20.3%) with melioidosis, 2/54 (3.7%) with leptospirosis and 1/21 (4.8%) with rickettsial disease. However, the APACHE II, APACHE III, SAPS II, and SOFA scores significantly overestimated the case-fatality rate of all the infections; the disparity between the predicted and observed mortality was most marked in the cases of leptospirosis and rickettsial disease. Commonly used SOI scores significantly overestimate the case-fatality rate of melioidosis, leptospirosis, and rickettsial infections in Australian ICU patients. This may be at least partly explained by the unique pathophysiology of these infections, particularly leptospirosis and rickettsial disease. However, SOI scores may still be useful in facilitating the comparison of disease severity in clinical trials that examine patients with these pathogens.

Bone and joint infections due to melioidosis; diagnostic and management strategies to optimise outcomes

“…This, in turn, is enabled by electronically promulgated management guidelines and reliable antibiotic supply chains. Although more than half of the patients resided in remote communities up to 900 kilometres from the hospital, an effective local hub-and-spoke model enabled early transfer to a tertiary hospital where patients were able to access collaborative, multidisciplinary care including sophisticated ICU support, specialist orthopaedic services, aggressive source control and prolonged antibiotic therapy [ 14 , 15 ].…”

The Incidence of Infection Complicating Snakebites in Tropical Australia: Implications for Clinical Management and Antimicrobial Prophylaxis

“…The risk of infection in our cohort is likely to have been mitigated by the patients promptly seeking medical attention in Australia's well-resourced universal health system. Indeed, over 98% of people living in rural and remote settings were able to be reviewed within 8 hours of their initial presentation at a tertiary referral hospital, emphasising the effectiveness of the hub-and-spoke model of care in regional Australia [ 26 , 27 ]. Despite the remote, tropical setting of the study, only a single case had a foreign body or soiling of the wound, suggesting that environmental contamination of the wound was a rare phenomenon.…”

The Epidemiological, Clinical, and Microbiological Features of Patients with Burkholderia pseudomallei Bacteraemia—Implications for Clinical Management

“…Although the presence of bacteraemia was associated with septic shock, ICU admission, and a significantly increased risk of death, these high-risk patients are likely to be identified by the derangement of other more easily collected clinical and laboratory indices, which are more accessible in the rural and remote and low-and middle-income settings that have a greater burden of the disease [22][23][24][25]. Bacteraemia clearly has prognostic utility for a variety of pathogens [26]; however, it is notable that the median TTP of B. pseudomallei-31 h in this series-is significantly longer than for other common Gram-negative pathogens [27].…”