The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis.

Criteria defining the systemic inflammatory response syndrome (SIRS) were used to assess prospectively 270 clinical episodes in which blood cultures were taken from patients in general medicine. SIRS, severe sepsis and septic shock occurred in 149 (55%), 13 (5%) and 9 (3%) episodes, respectively. However, evidence of organ hypoperfusion indicating severe sepsis was recorded as sought in only 26% of episodes of SIRS. Crude mortality at 28 days increased sequentially as more SIRS criteria were met, rising from 12% in non-SIRS blood culture episodes, to 36% when all four criteria were met. Mortality from severe sepsis and septic shock was 38% and 56%, respectively. In 61/64 (95%) episodes of clinically important bacteraemia, patients fulfilled SIRS criteria when the blood culture was taken. However, the positive predictive value of SIRS for predicting bacteraemia was only 7%. Patients who did not fulfil SIRS criteria when blood cultures were taken were at low risk of bacteraemia and comprised 45% (121/270) of the study population. Three patients in this low-risk group had bacteraemia. Mortality in bacteraemic patients with severe sepsis or septic shock who were initially treated with ineffective antibiotics for up to 48 h was 80%, compared to 42% in those always treated appropriately.

[1]  P. Gross,et al.  Applying a standard of care to the quality assessment of bacteremia. , 1992 .

[2]  Z. Saul,et al.  Applying a Standard of Care to the Quality Assessment of Bacteremia , 1992, Infection Control & Hospital Epidemiology.

[3]  J. Fuhrer,et al.  Clinical impact of rapid identification and susceptibility testing of bacterial blood culture isolates , 1989, Journal of clinical microbiology.

[4]  L. Leibovici,et al.  Bacteremia in febrile patients. A clinical model for diagnosis. , 1991, Archives of internal medicine.

[5]  C. Kunin.  9. Penicillinase-Resistant Penicillins: Veterans Administration Ad Hoc Interdisciplinary Advisory Committee on Antimicrobial Drug Usage , 1977 .

[6]  L. Leibovici,et al.  Bacteremia and fungemia of unknown origin in adults. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[7]  R. Thomson,,et al.  Difficulty in predicting bacteremia in elderly emergency patients. , 1992, Annals of emergency medicine.

[8]  W. R. Mccabe,et al.  Gram-negative bacteremia: IV. Re-evaluation of clinical features and treatment in 612 patients , 1980 .

[9]  M. Weinstein.  Clinical importance of blood cultures. , 1994, Clinics in laboratory medicine.

[10]  E. Cook,et al.  Predicting bacteremia in hospitalized patients. A prospectively validated model. , 1990, Annals of internal medicine.

[11]  R Gleckman,et al.  Afebrile bacteremia. A phenomenon in geriatric patients. , 1982, JAMA.

[12]  L Goldman,et al.  Contaminant blood cultures and resource utilization. The true consequences of false-positive results. , 1991, JAMA.

[13]  M. Weinstein,et al.  The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations, with special reference to factors influencing prognosis. , 1983, Reviews of infectious diseases.

[14]  D. Shanson.  Blood culture technique: current controversies. , 1990, The Journal of antimicrobial chemotherapy.

[15]  D. Pittet,et al.  The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. , 1995, JAMA.

[16]  W. Knaus,et al.  Evaluation of definitions for sepsis. , 1992, Chest.

[17]  O. Lehtonen,et al.  Antimicrobial therapy of septicemic patients in intensive care units before and after blood culture reporting. , 1991, Scandinavian journal of infectious diseases.

[18]  J. Parrillo,et al.  Prognostic factors in sepsis: The cold facts , 1992, Critical care medicine.

[19]  J. E. Carceller.  American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis , 1992, Critical care medicine.

[20]  D Greenwood,et al.  An analysis of community and hospital-acquired bacteraemia in a large teaching hospital in the United Kingdom. , 1987, The Quarterly journal of medicine.

[21]  E. P. Dellinger,et al.  Quality standard for the treatment of bacteremia. The Infectious Diseases Society of America. , 1994, Infection control and hospital epidemiology.

[22]  J. Mylotte,et al.  Validation of a Bacteremia Prediction Model , 1995, Infection Control & Hospital Epidemiology.

[23]  L. Leibovici,et al.  Patients at risk for inappropriate antibiotic treatment of bacteraemia , 1992, Journal of internal medicine.

[24]  D. Snydman,et al.  Influence of blood culture results on antibiotic choice in the treatment of bacteremia. , 1994, Archives of internal medicine.