title: Neither Single nor a Combination of Routine Laboratory Parameters can Discriminate between Gram-positive and Gram-negative Bacteremia.
abstract: Adequate early empiric antibiotic therapy is pivotal for the outcome of patients with bloodstream infections. In clinical practice the use of surrogate laboratory parameters is frequently proposed to predict underlying bacterial pathogens; however there is no clear evidence for this assumption. In this study, we investigated the discriminatory capacity of predictive models consisting of routinely available laboratory parameters to predict the presence of Gram-positive or Gram-negative bacteremia. Major machine learning algorithms were screened for their capacity to maximize the area under the receiver operating characteristic curve (ROC-AUC) for discriminating between Gram-positive and Gram-negative cases. Data from 23,765 patients with clinically suspected bacteremia were screened and 1,180 bacteremic patients were included in the study. A relative predominance of Gram-negative bacteremia (54.0%), which was more pronounced in females (59.1%), was observed. The final model achieved 0.675 ROC-AUC resulting in 44.57% sensitivity and 79.75% specificity. Various parameters presented a significant difference between both genders. In gender-specific models, the discriminatory potency was slightly improved. The results of this study do not support the use of surrogate laboratory parameters for predicting classes of causative pathogens. In this patient cohort, gender-specific differences in various laboratory parameters were observed, indicating differences in the host response between genders.
authors.affiliation: Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Ratzinger
authors.affiliation: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Austria.
authors.forename: Michel
authors.initials: M
authors.lastname: Dedeyan
authors.affiliation: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Rammerstorfer
authors.affiliation: Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Perkmann
authors.affiliation: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Burgmann
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Makristathis
authors.affiliation: Section for Artificial Intelligence, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna.
authors.forename: Georg
authors.initials: G
authors.lastname: Dorffner
authors.affiliation: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Austria.
authors.forename: Felix
authors.initials: F
authors.lastname: Loetsch
authors.affiliation: Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Währinger Gürtel 18-20 1090, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Blacky
authors.affiliation: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Austria.|Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity