title: Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome.
abstract: The purpose of this study was to determine the impact of bacteremia on intensive care unit (ICU) mortality and to develop a bacteremia prediction tool using systemic inflammatory response syndrome (SIRS) criteria.
  
  
  
  Patients included those aged >18 years who had blood cultures taken in the ICU from January 1, 2011-December 31, 2013. Eligible patients were identified from microbiology records of the Glasgow Royal Infirmary, Scotland. Clinical and outcome data were gathered from ICU records. Patients with clinically significant bacteremia were matched to controls using propensity scores. SIRS criteria were gathered and used to create decision rules to predict the absence of bacteremia. The main outcome was mortality at ICU discharge. The utility of the decision tools was measured using sensitivity and specificity.
  
  
  
  One hundred patients had a clinically significant positive blood culture and were matched to 100 controls. Patients with bacteremia had higher ICU mortality (odds ratio [OR], 2.35; P = .001) and longer ICU stay (OR, 17.0 vs 7.8 days; P ≤ .001). Of 1,548 blood culture episodes, 1,274 met ≥2 SIRS criteria (106 significant positive cultures and 1,168 negative cultures). There was no association between SIRS criteria and positive blood cultures (P = .11). A decision rule using 3 SIRS criteria had optimal predictive performance (sensitivity, 56%; specificity, 50%) but low accuracy.
  
  
  
  ICU patients with bacteremia have increased mortality and length of ICU stay. SIRS criteria cannot be used to identify patients at low risk of bacteremia.
authors.affiliation: School of Medicine, College of Medical, Veterinary and Life Sciences, The University of Glasgow, Glasgow, Scotland, UK. Electronic address: daniel.brooks@newcastle.ac.uk.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brooks
authors.affiliation: College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: School of Medicine, College of Medical, Veterinary and Life Sciences, The University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Douglas
authors.initials: D
authors.lastname: Young
authors.affiliation: Institute of Cardiovascular and Medical Sciences, Gardiner Institute, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Fulton
authors.affiliation: Royal Infirmary, Glasgow, Scotland, UK.
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Booth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis* / Q000401:mortality*; D003422:Critical Care; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D012680:Sensitivity and Specificity; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000473:pathology*; D055815:Young Adult
keywords: Intensive care; SIRS; bacteremia; decision support techniques; length of stay; mortality