qSOFA does not predict bacteremia in patients with severe manifestations of sepsis

Matthew P. Cheng, Katryn Paquette, Alexander Lawandi, Sarah N. Stabler, Murtaza Akhter, Adam C. Davidson, Marko Gavric, Rehman Jinah, Zahid Saeed, Koray Demir, Sassan Sangsari, Kelly Huang, Amirali Mahpour, Chris Shamatutu, Chelsea Caya, Jean Marc Troquet, Greg Clark, Barret Rush, Titus Wong, Robert StenstromDavid Sweet, Cedric P. Yansouni

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Bloodstream infections in septic patients may be missed due to preceding antibiotic therapy prior to obtaining blood cultures. We leveraged the FABLED cohort study to determine if the quick Sequential Organ Failure Assessment (qSOFA) score could reliably identify patients at higher risk of bacteremia in patients who may have false negative blood cultures due to previously administered antibiotic therapy. METHODS: We conducted a multi-centre diagnostic study among adult patients with severe manifestations of sepsis. Patients were enrolled in one of seven participating centres between November 2013 and September 2018. All patients from the FABLED cohort had two sets of blood cultures drawn prior to the administration of antimicrobial therapy, as well as additional blood cultures within 4 hours of treatment initiation. Participants were categorized according to qSOFA score, with a score ≥2 being considered positive. RESULTS: Among 325 patients with severe manifestations of sepsis, a positive qSOFA score (defined as a score ≥2) on admission was 58% sensitive (95% CI 48% to 67%) and 41% specific (95% CI 34% to 48%) for predicting bacteremia. Among patients with negative post-antimicrobial blood cultures, a positive qSOFA score was 57% sensitive (95% CI 42% to 70%) and 42% specific (95% CI 35% to 49%) to detect patients who were originally bacteremic prior to the initiation of therapy. CONCLUSIONS: Our results suggest that the qSOFA score cannot be used to identify patients at risk for occult bacteremia due to the administration of antibiotics pre-blood culture.

Original languageEnglish (US)
Pages (from-to)364-368
Number of pages5
JournalJournal of the Association of Medical Microbiology and Infectious Disease Canada
Issue number4
StatePublished - Dec 2022

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases


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