ABSTRACT
INTRODUCTION: Culture of emergency room blood samples is common practice, but open to controversy. As compared to other emergency tests, blood collection requires twice as much time and needs a refined technique to avoid contamination, and the study has no immediate diagnostic utility. METHODS: This prospective study includes consecutive adult patients with positive emergency room blood cultures. We analyzed the diagnostic sensitivity and contamination rate of the cultures and the etiology, clinical features and prognosis of the bacteremias encountered. RESULTS: During the study period, 5.2 blood cultures were indicated per 1000 patients attended in the emergency room. The diagnostic yield (positive blood cultures/total cultures) was 20% and the contamination rate (contaminated blood cultures/total cultures) was 1%. The incidence of bacteriemia was 0.99 episodes per 1000 patients attended in the emergency room and 10.3 episode per 1000 hospitalized patients. Gram-negative bacteria predominated (57%). Sepsis was the most frequent clinical manifestation (50%), followed by severe sepsis (40%) and septic shock (10%). Mortality was 22%. Diabetes mellitus and severe sepsis/septic shock were independent factors associated with mortality. CONCLUSIONS: Diagnostic performance and quality of emergency room blood cultures was high. The predominant etiology was gram-negative bacteria. Patients had a severe clinical presentation. Diabetes mellitus and severe sepsis and/or septic shock were independent prognostic factors of mortality.
Subject(s)
Bacteremia/diagnosis , Blood/microbiology , Emergency Service, Hospital/statistics & numerical data , Adult , Aged , Bacteremia/epidemiology , Bacteremia/microbiology , Cohort Studies , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Diabetes Complications/microbiology , Female , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Hospital Mortality , Hospitals, University/statistics & numerical data , Humans , Incidence , Life Tables , Male , Middle Aged , Predictive Value of Tests , Prognosis , Prospective Studies , Reproducibility of Results , Risk Factors , Sepsis/diagnosis , Sepsis/epidemiology , Sepsis/microbiology , Shock, Septic/diagnosis , Shock, Septic/epidemiology , Shock, Septic/microbiology , Spain/epidemiology , Survival Analysis , Urinary Tract Infections/complicationsABSTRACT
INTRODUCCIÓN. La realización de hemocultivos en el servicio de urgencias es una práctica común pero discutida porque, comparada con otros análisis de urgencias, requieren el doble de tiempo para la extracción y una técnica depurada para evitar contaminaciones, y carecen de utilidad diagnóstica inmediata. MÉTODOS. Estudio prospectivo de todos los pacientes adultos con hemocultivos positivos realizados en el servicio de urgencias y análisis de la rentabilidad, la calidad, la incidencia, la etiología, la clínica y el pronóstico de estas bacteriemias. RESULTADOS. Durante el período de estudio se indicaron 5,2 hemocultivos por cada 1.000 pacientes atendidos en urgencias. La rentabilidad diagnóstica (n.º de bacteriemias/n.º de hemocultivos realizados) fue del 20% y la tasa de contaminación (n.º de contaminantes/n.º de hemocultivos realizados) fue del 1%. La incidencia de bacteriemia fue de 0,99 episodios por cada 1.000 pacientes atendidos en el servicio de urgencias y de 10,3 episodios por cada 1.000 ingresos. La etiología predominante fueron las bacterias gramnegativas (57%). La sepsis fue la manifestación clínica más frecuente (50%), seguida de la sepsis grave (40%) y del shock séptico (10%).La mortalidad fue del 22%. La diabetes mellitus y la sepsis grave/shock séptico fueron los factores independientes asociados con la mortalidad. CONCLUSIONES. La rentabilidad y la calidad de los hemocultivos en el servicio de urgencias es elevada. Las bacterias gramnegativas son la etiología predominante. La presentación clínica de los pacientes con bacteriemia es grave y los factores independientes de mal pronóstico son la diabetes mellitus y la sepsis grave y/o el shock séptico (AU)
INTRODUCTION. Culture of emergency room blood samples is common practice, but open to controversy. As compared to other emergency tests, blood collection requires twice as much time and needs a refined technique to avoid contamination, and the study has no immediate diagnostic utility. METHODS. This prospective study includes consecutive adult patients with positive emergency room blood cultures. We analyzed the diagnostic sensitivity and contamination rate of the cultures and the etiology, clinical features and prognosis of the bacteremias encountered. RESULTS. During the study period, 5.2 blood cultures were indicated per 1000 patients attended in the emergency room. The diagnostic yield (positive blood cultures/total cultures) was 20% and the contamination rate(contaminated blood cultures/total cultures) was 1%.The incidence of bacteriemia was 0.99 episodes per 1000 patients attended in the emergency room and 10.3 episode per 1000 hospitalized patients. Gram-negative bacteria predominated (57%). Sepsis was the most frequent clinical manifestation (50%), followed by severe sepsis (40%) and septic shock (10%). Mortality was 22%. Diabetes mellitus and severe sepsis/septic shockwere independent factors associated with mortality. CONCLUSIONS. Diagnostic performance and quality of emergency room blood cultures was high. The predominant etiology was gram-negative bacteria. Patients had a severe clinical presentation. Diabetes mellitus and severe sepsis and/or septic shock were independent prognostic factors of mortality (AU)
