The impact of appropriateness of antimicrobial therapy in adults with occult bacteraemia

Lee, Ching Chi; Hong, Ming Yuan; Chan, Tsung Yu; Hsu, Hui‐Ping; Ko, Wen Chien

doi:10.1136/emermed-2012-201941

Cited by 8 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A previous study of intra-abdominal infections reported that misdiagnosis resulted in inadequate or delayed source control [11]. Other studies have shown that an inappropriate choice of antibiotic therapy, due to inappropriate diagnosis, has been related to poor outcomes [12, 13]. In addition, a retrospective cohort study at an academic hospital reported that vague symptoms, which were not specific to infection, were associated with delayed antibiotic administration and a higher risk of mortality [14].…”

Section: Discussionmentioning

confidence: 99%

In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission

et al. 2019

View full text Add to dashboard Cite

Background Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aimed to investigate the relationship between misdiagnosis of the site of infection at initial examination and in-hospital mortality. Methods This was a secondary-multicenter prospective cohort study involving 37 emergency departments. Consecutive adult patients with infection from December 2017 to February 2018 were included. Misdiagnosis of the site of infection was defined as a discrepancy between the suspected site of infection at initial examination and that at final diagnosis, including those infections remaining unidentified during hospital admission, whereas correct diagnosis was defined as site concordance. In-hospital mortality was compared between those misdiagnosed and those correctly diagnosed. Results Of 974 patients included in the analysis, 11.6% were misdiagnosed. Patients diagnosed with lung, intra-abdominal, urinary, soft tissue, and CNS infection at the initial examination, 4.2%, 3.8%, 13.6%, 10.9%, and 58.3% respectively, turned out to have an infection at a different site. In-hospital mortality occurred in 15%. In both generalized estimating equation (GEE) and propensity score-matched models, misdiagnosed patients exhibited higher mortality despite adjustment for patient background, site infection, and severity. The adjusted odds ratios (misdiagnosis vs. correct diagnosis) for in-hospital mortality were 2.66 (95% CI, 1.45–4.89) in the GEE model and 3.03 (95% CI, 1.24–7.38) in the propensity score-matched model. The difference in the absolute risk in the GEE model was 0.11 (0.04–0.18). Conclusions Among patients with infection, misdiagnosed site of infection is associated with a > 10% increase in in-hospital mortality. Electronic supplementary material The online version of this article (10.1186/s13054-019-2475-9) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission

et al. 2019

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Some previous studies noted that a milder severity of symptoms on ER presentation (as assessed using the Pittsburgh Bacteremia Score) was associated with the decision to discharge patients after blood culture collection [ 8 , 9 ]. In the present study, the absence of abnormal vital signs, including hypotension and AMS, at ER presentation, likely indicated milder disease severity and was the most powerful factor in the discharge from the ER of patients who later received a BSI diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Multivariate logistic regression was performed to identify the factors associated with the discharge of patients with BSI. In previous studies, a history of cerebrovascular disease [ 10 ], chronic heart failure, chronic lung disease [ 9 ], and the initial diagnosis [ 8–11 ] were associated with discharge. These factors were therefore included in the prediction model in the present study.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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

Miwa

Takamatsu

Honda

2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background Some patients receive the diagnosis of bloodstream infection (BSI) after discharge from the emergency room (ER). Because the safety of discharging patients after a blood culture collection is unknown, the present study aimed to investigate the prevalence, outcomes, and factors associated with BSI diagnosed after ER discharge. Methods This monocentric, case-control study compared patients who received a BSI diagnosis after ER discharge with those who were admitted for BSI. Factors associated with ER discharge after a blood culture collection were identified using multivariate logistic regression analysis. Results Between January 2014 and December 2020, 5.5% (142/2575) of patients with BSI visiting the ER were initially discharged. This occurred more commonly during the coronavirus disease 2019 (COVID-19) pandemic in 2020. On multivariate analysis, factors independently associated with the discharge of patients with BSI were the absence of hypotension (adjusted odds ratio [aOR], 15.71 [95% confidence interval {CI}, 3.45–71.63]), absence of altered mental status in the ER (aOR, 8.99 [95% CI, 3.49–23.14]), unknown origin at ER discharge (aOR, 4.60 [95% CI, 2.43–8.72]), and low C-reactive protein (aOR, 3.60 [95% CI, 2.19–5.93]). No difference in 28-day mortality was observed between the groups. Conclusions BSI is occasionally diagnosed after ER discharge. The prevalence of BSI diagnosed after ER discharge may have increased during the COVID-19 pandemic. Normal vital signs, unknown origin at ER discharge, and low C-reactive protein were important considerations leading to the discharge of these patients.

show abstract

“…1 Blood cultures are purported to improve outcomes by ensuring appropriate antibiotic therapy in patients with sepsis. 2 They have been shown to detect 80% of patients with bacteraemia when one set of cultures is taken, rising to over 90% when two sets of cultures are taken prior to antimicrobial therapy administration. 3 In medical patients with evidence of systemic inflammatory response syndrome (SIRS), blood cultures have been shown to be positive in 24% of cases, as opposed to 14% of those without SIRS.…”

mentioning

confidence: 99%

Blood cultures in acute surgical admissions

Dunne

McDonald

Ratnayake

et al. 2015

annals

View full text Add to dashboard Cite

INTRODUCTION Obtaining blood cultures prior to the administration of antimicrobial therapy was a key recommendation of the 2012 UK Surviving Sepsis Campaign. Few studies have examined the effect blood cultures have on clinical management and there have been none on acute surgical admissions. This retrospective study sought to evaluate the effect of blood cultures on clinical management in acute surgical admissions. METHODS Data on acute surgical patients admitted between 1 January and 31 December 2012 were extracted from hospital records. Patients given intravenous antibiotics within 24 hours of admission were identified. Data collected included antibiotics administered, blood culture results, admission observations and white blood cell count. Case notes were reviewed for patients with positive cultures to establish whether the result led to a change in management. RESULTS Of 5,887 acute surgical admissions, 1,346 received intravenous antibiotics within 24 hours and 978 sets of blood cultures were taken in 690 patients. The recommended two sets of cultures were obtained in 246 patients (18%). Patients who had blood cultures taken had the same in-hospital mortality as those who had none taken (3.6% vs 3.5%, p=0.97). Blood cultures were positive in 80 cases (11.6%). The presence of systemic inflammatory response syndrome did not increase positivity rates (12.9% vs 10.3%, p=0.28). Overall, cultures altered management in two patients (0.3%). CONCLUSIONS Blood cultures rarely affect clinical management. In order to assess the additional value that blood cultures bring to sepsis management in acute surgical admissions, a prospective randomised trial focusing on outcome is needed.

show abstract

The impact of appropriateness of antimicrobial therapy in adults with occult bacteraemia

Abstract: For adults with occult bacteraemia, a lower severity of illness and death rate than those of bacteraemic patients hospitalised for ED visit could be demonstrated, demonstrating the importance of appropriate antibiotic therapy.

Cited by 8 publications

References 27 publications

In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission

In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission

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

Blood cultures in acute surgical admissions

Contact Info

Product

Resources

About