Li Changxiu, Wang Jing, Wang Qiushi, Liu Beibei, Dang Heqin, Li Jin, Hou Dapeng
Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China.
Department of Respiratory and Critical Care, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China.
Infect Drug Resist. 2022 Aug 10;15:4381-4391. doi: 10.2147/IDR.S373998. eCollection 2022.
To analyze the effect of a quick Pitt bacteremia score (qpitt) on the prognosis of patients with bloodstream infection (BSI) secondary to urinary tract infection (UTI) and to further explore its use in aiding appropriate selection of initial antibiotic treatment.
Medical records of patients with BSIs secondary to UTIs who were admitted to our hospital from January 2018 to December 2020 were retrospectively collected. To screen for independent risk factors, logistic analysis was conducted on statistically significant variables. The receiver operating characteristic (ROC) curve was drawn with prognosis and death as the state variables to evaluate the predictive value. Patients were grouped by qpitt 2-point cutoff, to explore the impact of initial antimicrobial treatment regimens on poor prognosis and death in different subgroups. Poor prognosis was defined as a hospital length of stay (HLOS) ≥14 days or death within 28 days from BSI onset (ie, 28-day death).
A total of 266 patients were included in this study. In BSIs secondary to UTIs, we observed a pathogenic composition of 77.44% Gram-negative bacteria, 19.55% Gram-positive bacteria, and 3.01% fungi. The qpitt had poor predictive value for poor prognosis [area under ROC (AUROC) = 0.653, p < 0.001], while it had a high predictive value for death (AUROC = 0.890, p < 0.001). For patients with a qpitt ≥2, the poor prognosis and death rates of patients who were initially treated with carbapenem antibiotics were lower (p < 0.01). In comparison, initial treatment with carbapenem antibiotics had no significant effect on prognosis and death rates in patients with qpitt <2 (p > 0.1).
The qpitt is highly predictive for death in patients with BSIs secondary to UTIs and can be used to inform first-line antibiotic treatment strategy.
分析快速匹兹堡菌血症评分（qpitt）对尿路感染（UTI）继发血流感染（BSI）患者预后的影响，并进一步探讨其在辅助合理选择初始抗生素治疗中的应用。
回顾性收集2018年1月至2020年12月我院收治的UTI继发BSI患者的病历。对具有统计学意义的变量进行逻辑分析以筛选独立危险因素。以预后和死亡作为状态变量绘制受试者工作特征（ROC）曲线来评估预测价值。根据qpitt 2分的临界值对患者进行分组，以探讨初始抗菌治疗方案对不同亚组患者预后不良和死亡的影响。预后不良定义为住院时间（HLOS）≥14天或自BSI发病起28天内死亡（即28天死亡）。
本研究共纳入266例患者。在UTI继发的BSI中，我们观察到病原菌构成中革兰阴性菌占77.44%，革兰阳性菌占19.55%，真菌占3.01%。qpitt对预后不良的预测价值较差[ROC曲线下面积（AUROC）=0.653，p<0.001]，而对死亡具有较高的预测价值（AUROC = 0.890，p<0.001）。对于qpitt≥2的患者，初始使用碳青霉烯类抗生素治疗的患者预后不良和死亡率较低（p<0.01）。相比之下，初始使用碳青霉烯类抗生素治疗对qpitt<2的患者的预后和死亡率无显著影响（p>0.1）。
qpitt对UTI继发BSI患者的死亡具有高度预测性，可用于指导一线抗生素治疗策略。
