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

Abstract

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.

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.…”

“…This finding raises the question of the potential value of routine antimicrobial therapy in patients discharged after a blood culture collection. Nevertheless, previous studies noted that patients with a BSI after ER discharge were less likely to receive appropriate antimicrobial therapy than those with a BSI who were admitted immediately [ 10 , 11 ], and that inappropriate antimicrobial therapy was associated with a high mortality rate or urgent readmission [ 5 , 9 ]. Moreover, antimicrobial therapy without appropriate diagnosis may counteract antimicrobial stewardship in the ER [ 25 ].…”

“…Patients with BSI generally require hospitalization and need parenteral antimicrobial therapy during the early course of illness. Because delayed or inappropriate initial antimicrobial therapy for BSI is associated with poor clinical outcomes even in patients without sepsis, appropriate management, including close monitoring and prompt initiation of antimicrobial therapy, is essential, especially in the emergency room (ER) setting [ 4 , 5 ]. Although a positive blood culture is the gold standard for diagnosing BSI, blood culture results are often not available quickly enough to impact clinical decision-making, particularly in the ER [ 6 ].…”

Distribution and drug resistance of pathogenic bacteria in emergency patients

“…In this study, its isolation rate ranked first for many years, and it was an extensively drug-resistant strain. Acinetobacter baumannii in the emergency department is mostly due to nosocomial infection during hospitalization[13,14], and there are few reports that Acinetobacter baumannii causes community infection.…”

Clinical Pharmacist Management of Bacteremia in a Community Hospital Emergency Department

“…ED patients with undiagnosed bacteremia who are discharged have a higher rate of unplanned hospitalization or readmission to the ED. 3 Prompt recognition of bacteremia and appropriate treatment are essential to ensure positive patient outcomes.…”