Clinical factors predictive of Gram-negative bloodstream infection at the Emergency Department.

Introduction: Bloodstream infection is a common condition at the Emergency Department (ED). Appropriate antibiotic therapy is also crucial for patients with bloodstream infection particularly at the ED. This study therefore aimed to find clinical factors predictive of types of bacterial pathogens in bloodstream infection patients presenting at the ED focused on Gram-negative bacterial infections. Methods: This was a retrospective study. The inclusion criteria were adult patients who were suspected for bloodstream infection defined by blood culture collection presenting at the ED and intravenous antibiotics were initiated during the ED visits. The study period was between January 1st, 2016 and December 31st, 2018. Clinical data of the eligible patients were retrieved from the ED database. Factors associated with Gram-negative infection were calculated by logistic regression analysis. Results: There were 727 patients at the ED who had positive blood culture for bacteria. Of those, 504 patients (69.33%) had positive blood culture for Gram-negative bacteria. There were three independent factors for Gram-negative infection including sex, solid organ malignancy, and body temperature. The highest adjusted odds ratio (95% confidence interval) was 2.004 (1.330, 3.020) for solid organ malignancy. Conclusions: Gram-negative bacterial infection was more prominent than Gram-positive bacterial infection in patients presenting at the ED (69.33%). Solid organ malignancy, being female, and a high body temperature were independent factors of Gram-negative bacterial infection.

Clinical factors associated with bloodstream infection at the emergency department.

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.