OBJECTIVES The aim was the development of early clinical failure criteria (ECFC) to predict unfavourable outcomes in patients with Gram-negative bloodstream infections (GN-BSI). METHODS Adults with community-onset GN-BSI who survived hospitalization for ≥72 hr at Prisma Health-Midlands hospitals in Columbia, SC, USA from January 1, 2010 to June 30, 2015 were identified. Multivariable logistic regression was used to examine the association between clinical variables between 72 and 96 hr after GN-BSI and unfavourable outcomes (28-day mortality or hospital length of stay >14 days from GN-BSI onset). RESULTS Among 766 patients, 225 (29%) had unfavourable outcomes. After adjustments for Charlson Comorbidity Index and appropriateness of empirical antimicrobial therapy in multivariable model, predictors of unfavourable outcomes included systolic blood pressure <100 mmHg or vasopressor use (adjusted odds ratio (aOR) 1.8, 95% confidence interval (CI) 1.2-2.9), heart rate >100 beats/minute (aOR 1.7, 95% CI 1.1-2.5), respiratory rate ≥22 breaths/minute or mechanical ventilation (aOR 2.1, 95% CI 1.4-3.3), altered mental status (aOR 4.5, 95% CI 2.8-7.1), and white blood cell count >12 000/mm3 (aOR 2.7, 95% CI 1.8-4.1) between 72 and 96 hr after index GN-BSI. Area under receiver operating characteristic curve of ECFC model in predicting unfavourable outcomes was 0.77 (0.84 and 0.71 in predicting 28-day mortality and prolonged hospitalization, respectively). CONCLUSIONS Risk of 28-day mortality or prolonged hospitalization can be estimated between 72 and 96 hr after GN-BSI using ECFC. These criteria may have clinical utility in management of GN-BSI and may improve methodology of future investigations assessing response to antimicrobial therapy based on a standard evidence-based definition of early clinical failure.

中文翻译：

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评估革兰氏阴性血流感染的早期临床失败标准。

目的目的是开发早期临床衰竭标准（ECFC），以预测革兰氏阴性血流感染（GN-BSI）患者的不良预后。方法确定2010年1月1日至2015年6月30日在美国南卡罗来纳州哥伦比亚的Prisma Health-Midlands医院住院≥72小时的社区发作性GN-BSI成人。多变量logistic回归用于检查GN-BSI后72到96小时之间的临床变量与不良结局（从GN-BSI起28天死亡率或住院时间> 14天）之间的关联。结果在766例患者中，有225例（29％）的预后不良。在调整了Charlson合并症指数和经验性抗生素治疗在多变量模型中的适用性后，不良结果的预测指标包括收缩压<100 mmHg或使用升压药（调整比值比（aOR）1.8，95％置信区间（CI）1.2-2.9），心率> 100次/分钟（aOR 1.7、95％CI 1.1 -2.5），呼吸频率≥22次/分钟或机械通气（aOR 2.1，95％CI 1.4-3.3），精神状态改变（aOR 4.5，95％CI 2.8-7.1）和白细胞计数> 12000 /指数GN-BSI后72至96小时之间的mm3（aOR 2.7，95％CI 1.8-4.1）。在预测不良结局时，ECFC模型的接受者工作特征曲线下的面积为0.77（在预测28天死亡率和住院时间延长时，分别为0.84和0.71）。结论可以在使用ECFC的GN-BSI后72至96小时内估计28天死亡或长期住院的风险。