| Summary: | Changxiu Li,1,* Jing Wang,2,* Qiushi Wang,3,4 Beibei Liu,4 Heqin Dang,1 Jin Li,5 Dapeng Hou4 1Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Taian, People’s Republic of China; 2Department of Respiratory and Critical Care, The Second Affiliated Hospital of Shandong First Medical University, Taian, People’s Republic of China; 3Simulation Teaching Center, Capital Medical University, Beijng, People’s Republic of China; 4Department of Intensive Care Unit, The Second Affiliated Hospital of Shandong First Medical University, Taian, People’s Republic of China; 5Department of Laboratory, The Second Affiliated Hospital of Shandong First Medical University, Taian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dapeng Hou, Department of Intensive Care Unit, The Second Affiliated Hospital of Shandong First Medical University, Taian, People’s Republic of China, Tel +86-18505386932, Email tyfyhdp@163.comPurpose: To analyze the effect of a quick Pitt bacteremia score (qpitt) on the prognosis of patients with bloodstream infection (BSI) secondary to urinary tract infection (UTI) and to further explore its use in aiding appropriate selection of initial antibiotic treatment.Methods: Medical records of patients with BSIs secondary to UTIs who were admitted to our hospital from January 2018 to December 2020 were retrospectively collected. To screen for independent risk factors, logistic analysis was conducted on statistically significant variables. The receiver operating characteristic (ROC) curve was drawn with prognosis and death as the state variables to evaluate the predictive value. Patients were grouped by qpitt 2-point cutoff, to explore the impact of initial antimicrobial treatment regimens on poor prognosis and death in different subgroups. Poor prognosis was defined as a hospital length of stay (HLOS) ≥ 14 days or death within 28 days from BSI onset (ie, 28-day death).Results: A total of 266 patients were included in this study. In BSIs secondary to UTIs, we observed a pathogenic composition of 77.44% Gram-negative bacteria, 19.55% Gram-positive bacteria, and 3.01% fungi. The qpitt had poor predictive value for poor prognosis [area under ROC (AUROC) = 0.653, p < 0.001], while it had a high predictive value for death (AUROC = 0.890, p < 0.001). For patients with a qpitt ≥ 2, the poor prognosis and death rates of patients who were initially treated with carbapenem antibiotics were lower (p < 0.01). In comparison, initial treatment with carbapenem antibiotics had no significant effect on prognosis and death rates in patients with qpitt < 2 (p > 0.1).Conclusion: The qpitt is highly predictive for death in patients with BSIs secondary to UTIs and can be used to inform first-line antibiotic treatment strategy.Keywords: bloodstream infection, urinary tract infection, a quick Pitt bacteremia score, antibiotics
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