Background
Methods
Cohort description
Data collection
Definition of exposure and outcomes
Confounders
Baseline comparisons of exposure groups
Propensity score analysis
Dealing with propensity scores close to 0 or 1 (non-positivity)
Unmeasured confounding
Results
First diagnosis incorrect (N = 341) | First diagnosis correct (N = 546) | Number of missing values1 | Standard mean difference (SMD) | |
---|---|---|---|---|
Median (IQR) or N (%) | Median (IQR) or N (%) | N (%) | ||
Age | 64 (54;72) | 66 (54;73) | 0.06 | |
Male | 213 (62.5) | 317 (58.1) | −0.09 | |
Blood sampling from an indwelling line | 56 (16.4) | 12 (2.2) | 185 (20.9) | −0.57 |
Infection caused by anaerobic bacteria | 17 (5.0) | 19 (3.5) | −0.07 | |
High risk pathogen | 209 (61.3) | 233 (42.7) | −0.38 | |
Infection caused by gram-positive bacteria | 187 (54.8) | 195 (35.7) | −0.39 | |
Presentation at outpatient clinic before hospital admission | 137 (40.2) | 362 (66.3) | 0.54 | |
Length of hospital stay ≥48 hours before developing bloodstream infection | 162 (47.5) | 122 (22.3) | −0.55 | |
Pre-treatment with antibiotics before developing bloodstream infection | 135 (39.8) | 127 (23.3) | 3 (0.3) | −0.36 |
Pre-treatment with antibiotic adequate | 33 (9.7) | 45 (8.2) | 5 (0.6) | −0.05 |
Source of infection: | ||||
• Urinary tract | 42 (12.3) | 189 (34.6) | 0.54 | |
• Gastro-intestinal | 98 (28.7) | 146 (26.7) | −0.04 | |
• Pulmonary | 17 (5.0) | 72 (13.2) | 0.29 | |
• Intravascular | 66 (19.4) | 44 (8.1) | −0.33 | |
• Skin and soft tissue | 18 (5.3) | 51 (9.3) | 0.16 | |
• Other | 15 (4.4) | 41 (7.5) | 0.13 | |
• Unknown | 82 (24.0) | 2 (0.4) | − 0.77 | |
High risk source of infection | 156 (45.8) | 304 (55.7) | 0.20 | |
Antibiotic treatment in 2 months before developing bloodstream infection | 194 (58.3) | 238 (45.1) | 26 (2.9) | −0.27 |
History of antibiotic resistance | 57 (16.7) | 73 (13.4) | 19 (2.1) | −0.09 |
Infection caused by resistant gram-negative bacteria in past 6 months | 21 (6.2) | 35 (6.4) | 0.01 | |
ICU admission in past 6 months | 47 (13.8) | 35 (6.4) | −0.25 | |
Admission to Dutch hospital in past 6 months | 188 (55.1) | 246 (45.1) | −0.20 | |
Chronic urological disease | 23 (6.8) | 107 (19.9) | 13 (1.5) | 0.39 |
Lives in nursery home | 14 (4.3) | 16 (3.1) | 38 (4.3) | −0.06 |
Immunocompromised | 209 (61.3) | 262 (48.0) | −0.27 | |
Prednisolone use | 131 (38.4) | 142 (26.0) | −0.27 | |
Diabetes mellitus | 60 (17.6) | 125 (22.9) | 0.13 | |
Neutropenia < 0.5 before developing bloodstream infection | 87 (25.5) | 26 (4.8) | −0.60 | |
History of stem cell transplantation | 46 (13.5) | 24 (4.4) | −0.32 | |
History of solid organ transplantation | 33 (9.7) | 82 (15.0) | 0.16 | |
Liver cirrhosis | 8 (2.3) | 12 (2.2) | −0.01 | |
Current malignancy | 129 (37.8) | 133 (24.4) | −0.29 | |
Dialysis | 10 (2.9) | 10 (1.8) | 2 (0.2) | −0.07 |
Fever | 187 (56.7) | 346 (64.7) | 22 (2.5) | 0.16 |
Hypotension | 57 (16.7) | 99 (18.1) | 0.04 | |
Tachycardia | 170 (49.9) | 303 (55.5) | 0.11 | |
Altered state of consciousness (includes somnolence and confusion) | 56 (16.4) | 83 (15.2) | −0.03 | |
Patient considered ‘ill’ by physician | 91 (26.7) | 130 (23.8) | −0.07 | |
PITT bacteraemia score | 1 (0;2) | 1 (0;2) | −0.18 | |
qSOFA score | 1 (0;2) | 1 (0;2) | 84 (9.5) | 0.12 |
qSOFA score missing | 31 (9.1) | 53 (9.7) | 0.02 | |
Resistance current pathogen | 58 (17.0) | 103 (18.9) | 0.05 | |
History of resistance of current pathogen and history of resistance known at baseline | 21 (6.2) | 30 (5.5) | 1 (0.1) | −0.03 |
ICU admission for two days or more at time of blood sampling | 31 (9.01) | 19 (3.5) | 1 (0.1) | −0.23 |
Building the propensity score model
Propensity score matching
First diagnosis incorrect (N = 171) | First diagnosis correct (N = 171) | Standard mean difference (SMD) | |
---|---|---|---|
Median (IQR) or N (%) | Median (IQR) or N (%) | ||
Age | 65 (54;74) | 67 (54;75) | 0.06 |
Male | 107 (62.6) | 107 (62.6) | 0.00 |
Blood sampling from an indwelling line | 8 (4.7) | 9 (5.3) | 0.03 |
Infection caused by anaerobic bacteria | 11 (6.4) | 9 (5.3) | −0.05 |
High risk pathogen | 89 (52.1) | 92 (53.8) | 0.04 |
Infection caused by gram-positive bacteria | 78 (45.6) | 80 (46.8) | 0.02 |
Presentation at outpatient clinic before hospital admission | 92 (53.8) | 83 (48.5) | − 0.11 |
Length of hospital stay ≥48 hours before developing bloodstream infection | 56 (32.8) | 61 (35.7) | 0.06 |
Pre-treatment with antibiotics before developing bloodstream infection | 50 (29.3) | 48 (28.1) | −0.03 |
Pre-treatment with antibiotic adequate | 15 (8.8) | 14 (8.2) | −0.02 |
Source of infection: | |||
• Urinary tract | 36 (21.1) | 35 (20.5) | −0.01 |
• Gastro-intestinal | 59 (34.5) | 60 (35.1) | 0.01 |
• Pulmonary | 14 (8.2) | 14 (8.2) | 0.00 |
• Intravascular | 34 (19.9) | 32 (18.7) | 0.03 |
• Skin and soft tissue | 14 (8.2) | 14 (8.2) | 0.00 |
• Other | 12 (7.0) | 11 (6.4) | −0.02 |
• Unknown | 4 (2.3) | 2 (1.2) | −0.09 |
High risk source of infection | 66 (38.6) | 62 (36.3) | −0.05 |
Antibiotic treatment in 2 months before developing bloodstream infection | 84 (49.1) | 88 (51.5) | 0.05 |
History of antibiotic resistance | 21 (12.3) | 16 (9.4) | −0.09 |
Infection caused by resistant gram-negative bacteria in past 6 months | 10 (5.9) | 8 (4.7) | −0.05 |
ICU admission in past 6 months | 16 (9.4) | 17 (9.9) | 0.02 |
Admission to Dutch hospital in past 6 months | 86 (50.3) | 83 (48.5) | −0.03 |
Chronic urological disease | 15 (8.8) | 11 (6.4) | −0.09 |
Lives in nursery home | 6 (3.5) | 6 (3.5) | 0.00 |
Immunocompromised | 88 (51.5) | 84 (49.1) | −0.05 |
Prednisolone use | 51 (29.8) | 51 (29.8) | 0.00 |
Diabetes mellitus | 35 (20.5) | 30 (17.5) | −0.07 |
Neutropenia < 0.5 before developing bloodstream infection | 22 (12.9) | 22 (12.9) | 0.00 |
History of stem cell transplantation | 7 (4.1) | 11 (6.4) | 0.10 |
History of solid organ transplantation | 20 (11.7) | 15 (8.8) | −0.10 |
Liver cirrhosis | 4 (2.3) | 5 (2.9) | 0.04 |
Current malignancy | 59 (34.5) | 56 (32.8) | −0.04 |
Dialysis | 5 (2.9) | 5 (2.9) | 0.00 |
Fever | 99 (57.9) | 101 (59.1) | 0.02 |
Hypotension | 25 (14.6) | 26 (15.2) | 0.02 |
Tachycardia | 89 (52.1) | 89 (52.1) | 0.00 |
Altered state of consciousness (includes somnolence and confusion) | 24 (14.0) | 23 (13.5) | −0.02 |
Patient considered ‘ill’ by physician | 43 (25.2) | 48 (28.1) | 0.07 |
PITT bacteraemia score | 1 (0;2) | 1 (0;2) | 0.00 |
qSOFA score | 1 (0;2) | 1 (0;1) | −0.03 |
qSOFA score missing | 8 (4.7) | 10 (5.9) | 0.05 |
Resistance current pathogen | 30 (17.5) | 30 (17.5) | 0.00 |
History of resistance of current pathogen and history of resistance known at baseline | 7 (4.1) | 9 (5.3) | 0.06 |
ICU admission for two days or more at time of blood sampling | 6 (3.5) | 7 (4.1) | 0.03 |
Type of analysis | AEMM% (95%CI) | AEMM% (95%CI) Double adjusted2 | N matched pairs |
---|---|---|---|
Matching, caliper 0.02 | 14.6 (7.6;21.6) | Not applicable | 171 |
Additional1: Matching, caliper 0.2 | 13.5 (6.5;20.4) | Not applicable | 171 |
Additional: Matching, caliper 0.5 | 13.5 (7.0;20.0) | Not applicable | 192 |
IPTW truncated (weights >99th percentile) | 13.3 (6.9;19.6) | 13.7 (7.4;19.9) | Not applicable |
Additional: IPTW truncated (weights > 10) | 11.8 (3.0;20.6) | 12.3 (4.1;20.6) | Not applicable |
Additional: IPTW untruncated | −4.2 (−36.1;27.7) | − 0.1 (−23.8;23.5) | Not applicable |
Propensity score weighting
Propensity scores close to 0 or 1 (non-positivity)
Propensity score 0.95 or higher (N = 80) | Propensity score < 0.95 (N = 726) | Standard mean difference (SMD) | |
---|---|---|---|
Median (IQR) or N (%) | Median (IQR) or N (%) | ||
Age | 66 (56;74) | 66 (54;73) | 0.00 |
Male | 55 (68.8) | 427 (58.8) | −0.21 |
Blood sampling from an indwelling line | 21 (26.3) | 43 (5.9) | −0.57 |
Infection caused by anaerobic bacteria | 2 (2.5) | 32 (4.4) | 0.10 |
High risk pathogen | 59 (73.8) | 340 (46.8) | −0.57 |
Infection caused by gram-positive bacteria | 51 (63.8) | 291 (40.1) | −0.49 |
Presentation at outpatient clinic before hospital admission | 24 (30.0) | 438 (60.3) | 0.64 |
Length of hospital stay ≥48 hours before developing bloodstream infection | 47 (58.8) | 202 (27.8) | −0.65 |
Pre-treatment with antibiotics before developing bloodstream infection | 35 (43.8) | 198 (27.3) | −0.35 |
Pre-treatment with antibiotic adequate | 8 (10.0) | 61 (8.4) | −0.06 |
Source of infection: | |||
• Urinary tract | 0 | 214 (29.5) | 0.91 |
• Gastro-intestinal | 3 (3.8) | 224 (30.9) | 0.77 |
• Pulmonary | 0 | 81 (11.2) | 0.50 |
• Intravascular | 7 (8.8) | 89 (12.3) | 0.11 |
• Skin and soft tissue | 0 | 61 (8.4) | 0.43 |
• Other | 0 | 44 (6.1) | 0.36 |
• Unknown | 70 (87.5) | 9 (1.2) | −3.48 |
High risk source of infection | 70 (87.5) | 348 (47.9) | −0.93 |
Antibiotic treatment in 2 months before developing bloodstream infection | 46 (57.5) | 350 (48.2) | −0.19 |
History of antibiotic resistance | 17 (21.3) | 101 (13.9) | −0.19 |
Infection caused by resistant gram-negative bacteria in past 6 months | 7 (8.8) | 45 (6.2) | −0.10 |
ICU admission in past 6 months | 18 (22.5) | 54 (7.4) | −0.43 |
Admission to Dutch hospital in past 6 months | 45 (56.3) | 346 (47.7) | −0.17 |
Chronic urological disease | 1 (1.3) | 119 (16.4) | 0.55 |
Lives in nursery home | 4 (5.0) | 25 (3.4) | −0.08 |
Immunocompromised | 52 (65.0) | 368 (50.7) | −0.29 |
Prednisolone use | 36 (45.0) | 202 (27.8) | −0.36 |
Diabetes mellitus | 12 (15.0) | 150 (20.7) | 0.15 |
Neutropenia < 0.5 before developing bloodstream infection | 29 (36.3) | 75 (10.3) | −0.64 |
History of stem cell transplantation | 13 (16.3) | 45 (6.2) | −0.32 |
History of solid organ transplantation | 7 (8.8) | 99 (13.5) | 0.15 |
Liver cirrhosis | 2 (2.5) | 15 (2.1) | −0.03 |
Current malignancy | 36 (45.0) | 206 (28.4) | −0.35 |
Dialysis | 2 (2.5) | 13 (1.8) | −0.05 |
Fever | 41 (51.3) | 455 (62.7) | 0.23 |
Hypotension | 17 (21.3) | 125 (17.2) | −0.10 |
Tachycardia | 35 (43.8) | 382 (52.6) | 0.18 |
Altered state of consciousness (includes somnolence and confusion) | 19 (23.8) | 107 (14.7) | −0.23 |
Patient considered ‘ill’ by physician | 19 (23.8) | 169 (23.3) | −0.01 |
PITT bacteraemia score | 1 (0;2) | 1 (0;2) | −0.35 |
qSOFA score | 1 (0;2) | 1 (0;2) | −0.04 |
qSOFA score missing | 8 (10.0) | 55 (7.6) | −0.09 |
Resistance current pathogen | 11 (13.8) | 136 (18.7) | 0.13 |
History of resistance of current pathogen and history of resistance known at baseline | 9 (11.3) | 37 (5.1) | −0.23 |
ICU admission for two days or more at time of blood sampling | 10 (12.5) | 27 (3.7) | −0.32 |