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Overview :
The difference between the Apache II score at the onset of
Staphylococcus aureus bacteremia and the Apache II score of the day before is
considered to be the result of the intervening bacteremia and corrects for any
prebacteremic conditions in the patient. Since the length and nature of therapy
with antibiotics is largely determined by the presence or absence of metastatic
abscesses with pursuant complications, the ability to determine the likely
outcome can help in determining the initial management of the patient.
delta-Apache II score =
= (Apache II score on the day of 1st positive blood culture)
- (Apache II score on day before)
where:
• Apache II
scores range from 0-71, with higher numbers indicating a higher risk of
death
Interpretation:
•
uncomplicated cases: no signs of septic shock and no evidence of metastatic
abscess
•
complicated: septic shock at the onset of bacteremia, or the presence of
metastatic abscesses later in the disease course
|
delta score |
uncomplicated |
complicated but
nonfatal |
complicated and
fatal |
|
<=3 |
95% |
0 |
5% |
|
4-6 |
91% |
3% |
6% |
|
7-9 |
25% |
31% |
44% |
|
>=10 |
0% |
13% |
87% |
Management:
(1)
uncomplicated cases of bacteremia: may often be treated with a 2 week course
with antistaphylococcal antibiotics after removal of an identified primary focus
of infection
(2)
complicated cases of bacteremia with metastatic abscesses: require 4-6 or more weeks of intravenous
therapy with high dose antistaphylococcal antibiotics
Limitations:
• Data is
based only on nosocomial infections. Community-acquired infections may have
different outcomes.
• The
influence of antibiotic resistant strains is not included.
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