Pariwat Phungoen1, Nunchalit Lerdprawat1, Kittisak Sawanyawisuth2, Verajit Chotmongkol2, Kamonwon Ienghong1, Sumana Sumritrin3, Korakot Apiratwarakul4. 1. Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, 123/2000 Mitraparp Rd, Muang, Khon Kaen, 40002, Thailand. 2. Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. 3. Accidental and Emergency Unit, Division of Nursing, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. 4. Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, 123/2000 Mitraparp Rd, Muang, Khon Kaen, 40002, Thailand. korakot@kku.ac.th.
Abstract
BACKGROUND: Bloodstream infection (BSI) is a common urgent condition at the emergency department (ED). However, current guidelines for diagnosis do not specify the juncture at which blood cultures should be taken. The decision whether or not to obtain hemoculture is based solely upon clinical judgment and potential outcomes of inappropriately ordered cultures. This study aimed to find clinical factors present on ED arrival that are predictive of bloodstream infection. METHODS: This study was conducted retrospectively at the ED of a single tertiary care hospital in Thailand. We included adult patients with suspected infection based on blood culture who were treated with intravenous antibiotics during their ED visit. Independent positive predictors for positive blood culture were calculated by logistic regression analysis. RESULTS: A total of 169,578 patients visited the ED during the study period, 12,556 (7.40%) of whom were suspected of infection. Of those, 8177 met the study criteria and were categorized according to blood culture results (741 positive; 9.06%). Six clinical factors, including age over 55 years, moderate to severe CKD, solid organ tumor, liver disease, history of chills, and body temperature of over 38.3 °C, were associated with positive blood culture. CONCLUSIONS: Clinical factors at ED arrival can be used as predictors of bloodstream infection.
BACKGROUND: Bloodstream infection (BSI) is a common urgent condition at the emergency department (ED). However, current guidelines for diagnosis do not specify the juncture at which blood cultures should be taken. The decision whether or not to obtain hemoculture is based solely upon clinical judgment and potential outcomes of inappropriately ordered cultures. This study aimed to find clinical factors present on ED arrival that are predictive of bloodstream infection. METHODS: This study was conducted retrospectively at the ED of a single tertiary care hospital in Thailand. We included adult patients with suspected infection based on blood culture who were treated with intravenous antibiotics during their ED visit. Independent positive predictors for positive blood culture were calculated by logistic regression analysis. RESULTS: A total of 169,578 patients visited the ED during the study period, 12,556 (7.40%) of whom were suspected of infection. Of those, 8177 met the study criteria and were categorized according to blood culture results (741 positive; 9.06%). Six clinical factors, including age over 55 years, moderate to severe CKD, solid organ tumor, liver disease, history of chills, and body temperature of over 38.3 °C, were associated with positive blood culture. CONCLUSIONS: Clinical factors at ED arrival can be used as predictors of bloodstream infection.
Authors: Marie K Jessen; Julie Mackenhauer; Anne Mette S W Hvass; Svend Ellermann-Eriksen; Simon Skibsted; Hans Kirkegaard; Henrik C Schønheyder; Nathan I Shapiro Journal: Eur J Emerg Med Date: 2016-02 Impact factor: 2.799
Authors: Andrew Rhodes; Laura E Evans; Waleed Alhazzani; Mitchell M Levy; Massimo Antonelli; Ricard Ferrer; Anand Kumar; Jonathan E Sevransky; Charles L Sprung; Mark E Nunnally; Bram Rochwerg; Gordon D Rubenfeld; Derek C Angus; Djillali Annane; Richard J Beale; Geoffrey J Bellinghan; Gordon R Bernard; Jean-Daniel Chiche; Craig Coopersmith; Daniel P De Backer; Craig J French; Seitaro Fujishima; Herwig Gerlach; Jorge Luis Hidalgo; Steven M Hollenberg; Alan E Jones; Dilip R Karnad; Ruth M Kleinpell; Younsuk Koh; Thiago Costa Lisboa; Flavia R Machado; John J Marini; John C Marshall; John E Mazuski; Lauralyn A McIntyre; Anthony S McLean; Sangeeta Mehta; Rui P Moreno; John Myburgh; Paolo Navalesi; Osamu Nishida; Tiffany M Osborn; Anders Perner; Colleen M Plunkett; Marco Ranieri; Christa A Schorr; Maureen A Seckel; Christopher W Seymour; Lisa Shieh; Khalid A Shukri; Steven Q Simpson; Mervyn Singer; B Taylor Thompson; Sean R Townsend; Thomas Van der Poll; Jean-Louis Vincent; W Joost Wiersinga; Janice L Zimmerman; R Phillip Dellinger Journal: Intensive Care Med Date: 2017-01-18 Impact factor: 17.440
Authors: Katrine P Lindvig; Stig L Nielsen; Daniel P Henriksen; Thøger G Jensen; Hans Jørn Kolmos; Court Pedersen; Pernille J Vinholt; Annmarie T Lassen Journal: Eur J Emerg Med Date: 2016-06 Impact factor: 2.799
Authors: Tom H Boyles; Kelly Davis; Thomas Crede; Jacques Malan; Marc Mendelson; Maia Lesosky Journal: BMC Infect Dis Date: 2015-10-06 Impact factor: 3.090
Authors: Deverick J Anderson; Rebekah W Moehring; Richard Sloane; Kenneth E Schmader; David J Weber; Vance G Fowler; Emily Smathers; Daniel J Sexton Journal: PLoS One Date: 2014-03-18 Impact factor: 3.240