As the Centers for Disease Control and Prevention (CDC) identified, complications or infections secondary to device implantation or surgery are called HAI(1).Tens of thousands of people are infected worldwide every year (2, 3). According to statistics data, about 2 million patients suffer from HAI each year in the United States with 99,000 total deaths, which costs 33 billion dollars each year(4, 5). In European, the number of people who die directly from HAI each year is about 37,000, and the total length of hospital stay increases by 1,600 Million(6). Bloodstream infection is one of the important infection types in HAI. Musicha P et al(7) showed that the mortality rate of bloodstream infection in HAI is higher, and the incidence of Klebsiella pneumoniae bloodstream infection in Enterobacteriaceae is in the forefront. CHINET(China Antimicrobial Surveillance Network) shows the isolation rate of Klebsiella pneumoniae bloodstream infection is 16.51%, which is the second place among bloodstream infection bacteria (8). What's worse is that the resistance rate of Klebsiella pneumoniae is increasing every year. According to calculations, 426,277 cases of HAI caused by antimicrobial drug-resistant microorganisms occur in the EU every year, and the number of deaths due to drug-resistant microorganisms in the EU is 33,110 each year(9). Therefore, the early assessment for the condition of patients with Klebsiella pneumoniae infection can effectively guide the selection of clinical treatment and the intensity of care levels, as to minimize the mortality rate and improve the prognosis. Then the criteria for evaluating the prognosis of the disease are particularly important. After continuous clinical practice, many scholars have formed a scoring system used in a variety of different scenarios. The Pitt bacteremia score and the SOFA score are currently two widely used clinical scoring system.
The Pitt bacteremia score was first proposed by Rasmussen HH et al(10) in 1985. Its scoring items include temperature, blood pressure, mechanical ventilation, cardiopulmonary resuscitation, and mental status. The total score is 18 points. The higher the score, the worse the prognosis. Recently, many studies confirmed that the Pitt bacteremia score has great significance for the prognosis assessment of acute and critical illness(11, 12), and many studies have shown that Pitt bacteremia score>4 can be used as a risk factor for death(13, 14), so it is widely recognized by domestic and foreign researchers and clinicians to evaluate the prognosis of critical patients. The SOFA score was first proposed in 1994 by the European Society of Intensive Care Medicine(15), and its purpose is to describe the occurrence, development and incidence of MODS. It includes the assessment of the respiratory system, coagulation system, liver, circulatory system, nervous system and kidneys. The total score is 40 points. The higher the score, the worse the prognosis. A number of studies have shown that SOFA scores can be used to evaluate the prognosis of critically ill patients(16, 17), so it is widely used in clinical evaluation of the prognosis of critically ill patients. However, there are still no relevant studies on the evaluation of the Pitt bacteremia score and SOFA score in the prognosis of patients with bloodborne infections.
This study retrospectively analyzed the prognostic evaluation of SOFA score and Pitt bacteremia score in 40 patients with hospital acquired Klebsiella pneumoniae bloodstream infection. The objective has explored the application value and advantages and disadvantages of SOFA score and Pitt bacteremia score in the prognosis evaluation of HAI patients with Klebsiella pneumoniae bloodstream infection.