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This study received no financial support. The promoter of this study was the Infectious Disease Group of the Spanish Emergency Medicine Society. This group received financial support from Merck, Tedec-Meiji, Thermo Fisher, ViroGates and GSK in the last year to organise conferences and group meetings. None of the authors has received any financial compensation.

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A bacteraemia risk prediction model: development and validation in an emergency medicine population

Publicado en:Infection. 50 (1): 203-221 - 2022-01-01 50(1), DOI: 10.1007/s15010-021-01686-7

Autores: Julian-Jimenez, Agustin; Gonzalez del Castillo, Juan; Garcia-Lamberechts, Eric Jorge; Huarte Sanz, Itziar; Navarro Bustos, Carmen; Rubio Diaz, Rafael; Guardiola Tey, Josep Maria; Llopis-Roca, Ferran; Pinera Salmeron, Pascual; de Martin-Ortiz de Zarate, Mikel; Alvarez-Manzanares, Jesus; Gamazo-Del Rio, Julio Javier; Alvarez Alonso, Marta; Mora Ordonez, Begona; alvarez Lopez, Oscar; Ortega Romero, Maria del Mar; Sousa Reviriego, Maria del Mar; Perales Pardo, Ramon; Villena Garcia del Real, Henrique; Ferreras Amez, Jose Maria; Gonzalez Martinez, Felix; Martin-Sanchez, Francisco Javier; Beneyto Martin, Pedro; Candel Gonzalez, Francisco Javier; Diaz-Honrubia, Antonio Jesus

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Objective Design a risk model to predict bacteraemia in patients attended in emergency departments (ED) for an episode of infection. Methods This was a national, prospective, multicentre, observational cohort study of blood cultures (BC) collected from adult patients (>= 18 years) attended in 71 Spanish EDs from October 1 2019 to March 31, 2020. Variables with a p value < 0.05 were introduced in the univariate analysis together with those of clinical significance. The final selection of variables for the scoring scale was made by logistic regression with selection by introduction. The results obtained were internally validated by dividing the sample in a derivation and a validation cohort. Results A total of 4,439 infectious episodes were included. Of these, 899 (20.25%) were considered as true bacteraemia. A predictive model for bacteraemia was defined with seven variables according to the Bacteraemia Prediction Model of the INFURG-SEMES group (MPB-INFURG-SEMES). The model achieved an area under the curve-receiver operating curve of 0.924 (CI 95%:0.914-0.934) in the derivation cohort, and 0.926 (CI 95%: 0.910-0.942) in the validation cohort. Patients were then split into ten risk categories, and had the following rates of risk: 0.2%(0 points), 0.4%(1 point), 0.9%(2 points), 1.8%(3 points), 4.7%(4 points), 19.1% (5 points), 39.1% (6 points), 56.8% (7 points), 71.1% (8 points), 82.7% (9 points) and 90.1% (10 points). Findings were similar in the validation cohort. The cut-off point of five points provided the best precision with a sensitivity of 95.94%, specificity of 76.28%, positive predictive value of 53.63% and negative predictive value of 98.50%. Conclusion The MPB-INFURG-SEMES model may be useful for the stratification of risk of bacteraemia in adult patients with infection in EDs, together with clinical judgement and other variables independent of the process and the patient.

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