Epidemiological and clinical characteristics of occult bacteremia in an adult emergency department in Spain: influence of blood culture results on changes in initial diagnosis and empiric antibiotic treatment

Ramos, José Manuel; Masiá, Mar; Elía, M.; Gutiérrez, Félix; Royo, Gloria; Bonilla, F.; Padilla, Sergio; Martín-Hidalgo, Alberto

doi:10.1007/s10096-004-1235-0

Cited by 23 publications

(26 citation statements)

References 14 publications

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“…Published guidelines for ordering BCs are, however, limited and there are few studies of the clinical utility of BCs. In the small numbers of studies done in adult ED populations, the true positive rate has been low (1.8-5%) with clinically useful results only seen in 0.5-1.6% [1][2][3] Most studies have found almost equal false-positive rates, and these are not without adverse consequence. The only study to quantify this was conducted in a paediatric ED but it showed significant untoward effects of false-positive BCs in terms of staff time, resource use and unnecessary patient treatment [4].…”

Section: Introductionmentioning

confidence: 95%

Blood cultures ordered in the adult emergency department are rarely useful

Mountain¹,

Bailey

O’Brien³

et al. 2006

European Journal of Emergency Medicine

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Objectives Although blood cultures are commonly ordered in the emergency department, there is controversy about their utility. This study aimed to determine the usefulness of blood cultures in the management of patients presenting to a tertiary adult teaching hospital emergency department in Perth, Western Australia.Methods A detailed chart review was undertaken of all blood cultures taken in our emergency department over a 2-month period. All patients within the hospital having blood cultures taken were identified; from this group, blood cultures originating from the emergency department were reviewed. Data were collected concerning patient demographics, culture indication, vital signs, culture outcome, disposition and alterations in management resulting from the blood culture.Results 218 blood cultures were ordered from the emergency department during the study period. This represented 4.0% (218/5478) of the total number of patients seen. Of the 218 cultures, only 30 were positive (13% of the study population), with 16 (7.3%) probable contaminants and 14 (6.4 %) true positives. No anaerobic isolates were identified. Of the 14 significantly positive blood cultures, the result influenced management in six patients, resulting in a useful culture rate of 2.8% (6/218).Conclusion Blood cultures are ordered on a significant number of patients seen in the emergency department but rarely alter management. Our findings in conjunction with other studies suggest that eliminating blood cultures in immunocompetent patients with common illnesses such as urinary tract infection, community acquired pneumonia and cellulitis, may significantly reduce the number of blood cultures, producing substantial savings without jeopardizing patient care. This needs prospective study and validation.

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Section: Introductionmentioning

confidence: 95%

Blood cultures ordered in the adult emergency department are rarely useful

Mountain¹,

Bailey

O’Brien³

et al. 2006

European Journal of Emergency Medicine

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“…[1][2][3][4][5][6][7] These studies have included between 5 4 and 247 5 patients discharged from single centres. Patients were typically followed until they were reassessed at the index department.…”

Section: Abstract: Administrative Data Bloodstream Infections Emergmentioning

confidence: 99%

Epidemiology and outcomes of bloodstream infections in patients discharged from the emergency department

Chan

Wong

Saginur

et al. 2015

CJEM

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Objective: To determine the outcomes of patients discharged from the emergency department (ED) with a bloodstream infection (BSI) and how these outcomes are influenced by antibiotic treatment. Methods: We identified every BSI in adult patients discharged from our ED to the community between July 1, 2002, and March 31, 2011. The medical records of all cases were reviewed to determine antibiotic treatment in the ED and at discharge. Microorganism sensitivities were used to determine whether antibiotics were appropriate. These data were linked to population-based administrative data to determine specific patient outcomes within the subsequent 2-week period: death, urgent hospitalization, or an unplanned return to the ED. Results: A total of 480 adults with BSI were identified (1.49 cases per 1,000 adults discharged from the department). Compared to controls (321,048 patients), BSI patients had a significantly higher risk of urgent hospitalization (adjusted OR 2.1 [95% CI 1.6-2.8]) and unplanned return to the ED (adjusted OR 4.1 [95% CI 3.3-4.9]). Outcome risk was significantly lowered in BSI patients who received appropriate antibiotics in the ED and at discharge. In elderly patients, the risk of urgent hospitalization increased significantly as the time to appropriate antibiotics was delayed. Conclusions: BSI patients discharged from the ED have a significantly increased risk of urgent hospitalization and unplanned return to the ED in the subsequent 2 weeks. These risks decrease significantly with the timely provision of appropriate antibiotics. Our results support the aggressive use of measures ensuring that such patients receive appropriate antibiotics as soon as possible. RÉ SUMÉObjectif: L'é tude visait à dé terminer les ré sultats cliniques chez des patients souffrant d'une infection hé matogè ne (IH) et renvoyé s du service des urgences (SU) et la faç on dont le traitement antibiotique influait sur ces ré sultats. Mé thode: Nous avons procé dé à la recherche de tous les cas d'IH observé s chez des adultes qui avaient é té renvoyé s du SU dans la collectivité , entre le 1er juillet 2002 et le 31 mars 2011. Les dossiers mé dicaux de tous les patients ont é té revus afin que soit dé terminé le traitement antibiotique prescrit au SU et au moment du congé . La pertinence des antibiotiques prescrits a é té é tablie en fonction de la sensibilité des micro-organismes. Les donné es recueillies ont é té lié es à des donné es administratives fondé es sur la population pour permettre de dé gager certains ré sultats cliniques au cours des 2 semaines suivantes: la mort, une hospitalisation urgente, ou un retour imprévu au SU.

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“…While the isolated coagulase negative staphylococci groups as contamination may have represented the actual pathogen responsible for the infection [4]. As results, we also considered patients with prosthetic device [4], recent surgery, immunosuppression (HIV or cancer patients receiving chemo/radiation therapy) [5,7], intravascular catheter [4,7], and history of drug addiction [5]. Similar criteria have been previously used by others [10].…”

Section: Discussionmentioning

confidence: 99%

“…e clinical relevance of bacteria commonly found in the skin �ora isolated in blood culture is oen di�cult to determine. In our study, coagulase-negative staphylococci, Streptococcus viridans, Corynebacterium spp., Bacillus spp., Micrococcus spp., Peptostreptococcus spp., Propionibacterium spp., Aerococcus species, Acinetobacter iwoffii, Clostridium perfringens, and aerobic spore forming gram positive rods were termed "skin �ora" and considered contaminating [4][5][6][7]. Isolates of coagulase negative staphylococci and alpha hemolytic streptococci were considered pathogenic if they were isolated from two or more blood cultures bottles and if the following conditions were met: being immunocompromised, whether an intravascular catheter or prosthetic device was present, and whether there was a history of IV drug abuse [6].…”

Section: Datamentioning

confidence: 99%

Positive Predictive Value of Blood Cultures Utilized by Community Emergency Physicians

Lin

Boehm

2013

ISRN Infectious Diseases

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Objective. To determine the positive predictive value of blood cultures obtained from patients from a suburban ED and how the ED physicians use empirical antibiotics. Method. is retrospective chart review study was conducted at the ED of a suburban teaching hospital. e study consisted of adult patients who presented to the ED with evidence of clinical conditions suggesting bacteremia. Result. Over a 12-month period, 408 patients with positive blood cultures were drawn in the ED. e mean age of the patients was 65.85 years. e positive predictive value was 58.3%, and community ED physicians used appropriate empirical antibiotics in 72.3% of patients with true bacteremia. Conclusion. e positive predictive value indicated that many of the positive blood culture results were false positives from skin contamination. Blood cultures are necessary to follow up any positive results with more reliable tests to obtain a more accurate assessment as to whether bacteremia is present in the emergency department. True positive blood cultures can assist other doctors in adjusting the antibiotics. Emergency physicians overall used appropriate antibiotics in 72.3% of patients with true bacteremia. is study demonstrated that emergency physicians have the potential to improve the empirical treatment in treating patients.

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Epidemiological and clinical characteristics of occult bacteremia in an adult emergency department in Spain: influence of blood culture results on changes in initial diagnosis and empiric antibiotic treatment

Cited by 23 publications

References 14 publications

Blood cultures ordered in the adult emergency department are rarely useful

Blood cultures ordered in the adult emergency department are rarely useful

Epidemiology and outcomes of bloodstream infections in patients discharged from the emergency department

Positive Predictive Value of Blood Cultures Utilized by Community Emergency Physicians

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