The aim of this study was to evaluate the usability of systemic inflammatory response syndrome (SIRS) and commonly used biochemical parameters as predictors for positive blood culture in patients with sepsis. The study included 313 patients aged ≥18 years with severe sepsis and septic shock consecutively admitted in the Intensive Care Unit (ICU) of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia. The study took place from January 1, 2011 to December 31, 2017. We recorded demographic variables, common laboratory tests, SIRS parameters, site of infection, comorbidities and Sequential Organ Failure Assessment (SOFA) score. Blood cultures were positive in 65 (20.8%) patients with sepsis. Gram-positive bacteria were isolated from 35 (53.8%) patients. From the evaluated variables in this study, only the presence of four SIRS parameters was associated with bacteremia, finding that will help to predict bacteremia and initiate early appropriate therapy in septic patients.
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1. Fleischmann C Scherag A Adhikari NK et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med 2016; 193(3): 259–72.
2. Gaieski DF Mikkelsen ME Band RA. et al. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 2010; 38: 1045–53.
3. Hoenigl M Raggam RB Wagner J et al. Diagnostic accuracy of soluble urokinase plasminogen activator receptor (suPAR) for prediction of bacteremia in patients with systemic inflammatory response syndrome. ClinBiochem 2013; 46: 225–9.
4. Wildi K Tschudin-Sutter S Dell-Kuster S et al. Factors associated with positive blood cultures in outpatients with suspected bacteremia. Eur J ClinMicrobiol Infect Dis 2011; 30: 1615–9.
5. Falguera M Trujillano J Caro S et al. A prediction rule for estimating the risk of bacteremia in patients with community-acquired pneumonia. Clin Infect Dis 2009; 49: 409–16.
6. Bone RC BR Cerra FB Dellinger RP et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644–55.
7. Kaukonen KM Bailey M Pilcher D et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med 2015; 372: 1629–1638.
8. Singer M Deutschman C Seymour C et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016; 315: 801–10.
9. Leth RA Forman BE Kristensen B. Predicting bloodstream infection via systemic inflammatory response syndrome or biochemistry. J Emerg Med 2013; 44: 550–7.
10. Jones GR Lowes JA. The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis. Q J Med 1996; 89: 515–22.
11. Dellinger RP Levy MM Rhodes A et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013; 41: 580–637.
12. Vincent JL et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22(7): 707–710.
13. Hall KK Lyman JA. Updated review of blood culture contamination. ClinMicrobiol Rev 2006; 19(4): 788–802.
14. Richter SS Beekmann SE Croco JL et al. Minimizing the workup of blood culture contaminants: implementation and evaluation of a laboratory-based algorithm. J ClinMicrobiol2002; 40: 2437–2444.
15. Wildi K Tschudin-Sutter S Dell-Kuster S et al. Factors associated with positive blood cultures in outpatients with suspected bacteremia. Eur J ClinMicrobiol Infect Dis 2011; 30: 1615–9.
16. Chou HL Han ST Yeh CF et al. Systemic inflammatory response syndrome is more associated with bacteremia in elderly patients with suspected sepsis in emergency departments. Medicine (Baltimore) 2016; 95(49): e5634.
17. Coburn B Morris AM Tomlinson G et al. Does this adult patient with suspected bacteremia require blood cultures? JAMA 2012; 308: 502–11.
18. Taniguchi T Tsuha S Takayama Y et al. Shaking chills and high body temperature predict bacteremia especially among elderly patients. Springer-plus 2013; 2: 624.
19. Gomolin IH Aung MM Wolf-Klein G et al. Older is colder: temperature range and variation in older people. J Am GeriatrSoc 2005; 53: 2170–2.
20. Phua J Ngerng W See K et al. Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit Care 2013; 17(5): R202.
21. Cretikos M. A. Bellomo R. Hillman K. et al. Respiratory rate: the neglected vital sign. Med. J. Aust2008; 188: 657–659.
22. Jaimes F Arango C Ruiz G et al. Predicting bacteraemia at the bedside. Clinical Infectious Diseases 2004; 38: 357–362.
23. Seigel TA Cocchi MN Salciccioli J et al. Inadequacy of temperature and white blood cell count in predicting bacteremia in patients with suspected infection. J Emerg Med 2012; 42: 254–9.
24. Brun-Buisson C Doyon F Carlet J et al. Incidence risk factors and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 1995; 274: 968–974.
25. Vincent JL Sakr Y Sprung CL et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006; 34: 344–353.
26. Routsi C Pratikaki M Sotiropoulou C et al. Application of the sequential organ failure assessment (SOFA) score to bacteremic ICU patients. Infection 2007; 35(4): 240–4.
27. Jansma G Buter H Gerritsen RT Boerma EC. Is hemoglobin concentration affected by sepsis in the acute phase?.Crit Care 2013;17(Suppl 2): P10.
28. Tsirigotis P Chondropoulos S Frantzeskaki F et al. Thrombocytopenia in critically ill patients with severe sepsis/septic shock: prognostic value and association with a distinct serum cytokine profile. J Crit Care 2016; 32: 9–15.
29. Mosevoll KA Skrede S Markussen DL et al. Inflammatory Mediator Profiles Differ in Sepsis Patients With and Without Bacteremia. Front Immunol 2018; 9: 691.
30. Kim B Choi J Kim K et al. Bacteremia Prediction Model for Community-acquired Pneumonia: External Validation in a Multicenter Retrospective Cohort. AcadEmerg Med 2017; 24(10): 1226–1234.