Blood cultures of adult patients discharged from the emergency department—is the safety net reliable?

Epidemiology and Factors Associated With Discharging Patients After Blood Culture Collection in the Emergency Department: A Case-Control Study in Japan

“…The present study found that overall mortality in patients with a BSI following ER discharge was low (3.9%) and no different from that in patients with a BSI who were admitted immediately. This finding is consistent with that of previous studies demonstrating that the mortality rate in patients with a BSI who were discharged from the ER ranged from 0% to 5.0% [ 5 , 9 , 11 , 17 , 18 , 20 ]. However, our study also found that a higher proportion of patients discharged with no antimicrobial therapy (ie, no antimicrobials were given at the ER visit or were prescribed on discharge) returned to the ER with sepsis or died within 28 days.…”

“…Moreover, antimicrobial therapy without appropriate diagnosis may counteract antimicrobial stewardship in the ER [ 25 ]. The present study also revealed that the subsequent diagnosis of BSI frequently differed from the initial, presumptive diagnosis made in the ER, possibly leading to inappropriate antimicrobial therapy, a finding corroborated by several, previous studies [ 17 , 18 , 20 ]. Thus, routine antimicrobial therapy before the discharge should be avoided in these patients.…”

“…The prevalence of ER discharge followed by a BSI diagnosis varied among previous studies from 2% to 27% [ 9 , 11 , 17–21 ]. In the present study, the prevalence of discharge followed by a BSI diagnosis was nearly 5%, indicating that a relatively small proportion of patients with BSI were inadvertently discharged from the ER.…”