title: Predicting abscesses in adults with community-onset monomicrobial Enterobacteriaceae bacteremia: microorganisms matters.
abstract: Enterobacteriaceae is a leading pathogen of community-onset bacteremia. This study aims to establish a predictive scoring algorithm to identify adults with community-onset Enterobacteriaceae bacteremia who are at risk for abscesses. Of the total 1262 adults, 152 (12.0%) with abscess occurrence were noted. The 6 risk factors significantly associated with abscess occurrence-liver cirrhosis, diabetes mellitus, thrombocytopenia and high C-reactive protein (>100 mg/L) at bacteremic onset, delayed defervescence, and bacteremia-causing Klebsiella pneumoniae-were each assigned +1 point to form the scoring algorithm. In contrast, the elderly, fatal comorbidity (McCabe classification), and bacteremia-causing Escherichia coli were each assigned -1 point, owing to their negative associations with abscess occurrence. Using the proposed scoring algorithm, a cut-off value of +1 yielded a high sensitivity (85.5%) and an acceptable specificity (60.4%). Although the proposed predictive model needs further validation, this simple scoring algorithm may be useful for the early identification of abscesses by clinicians.
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
authors.forename: Chung-Hsun
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan. Electronic address: chichingbm85@gmail.com.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Hsieh
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
authors.forename: Ming-Yuan
authors.initials: MY
authors.lastname: Hong
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan 704, Taiwan. Electronic address: chich@mail.ncku.edu.tw.
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Chi
mesh_terms: D000038:Abscess / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology; D003661:Decision Support Techniques; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Abscesses; Bacteremia; Enterobacteriaceae