Isolated pathogens and clinical outcomes of adult bacteremia in the emergency department: A retrospective study in a tertiary Referral Center

Chih Hsiang Kao, Yau Chang Kuo, Chih Chung Chen, Yun Te Chang, Yao Shen Chen, Shue Ren Wann, Yung Ching Liu

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Approximately two-thirds of the patients with severe sepsis or septic shock are first encountered in the emergency departments (EDs) of western countries, in which bacteremia is present in about 50% of patients with severe sepsis. The situation of bacteremia presenting to the EDs in Taiwan is not well documented. The objective of this study was to examine the epidemiology and microbiology of bacteremia in adult patients who visited the ED of a medical center in southern Taiwan. Methods: A retrospective observational study of the epidemiology and microbiology of bacteremia was conducted in the ED of a medical center involving 6,137 adult patients and 13,903 blood cultures. Results: A total of 831 consecutive patients with 890 episodes of bacteremia were obtained from January 1 to December 31, 2004, indicating a positive culture rate of 13.5% (1,872/13,903). Among these episodes, 525 (59%) were defined as true community-acquired infections followed by 263 (29.5%) as health care-associated infections and 102 (11.5%) as nosocomial infections. Of the 972 isolates, 289 (29.7%) were gram-positive species and 683 (70.3%) were gram-negative species. Urinary tract infections (32.2%, 287/890) were most common in these patients, with Escherichia coli (30.8%, 299/972) being the most common pathogen. Bacteremia caused by Staphylococcus aureus was more common in nosocomial than true community-acquired infections (31.3% vs. 12%) and had significantly higher possibility of resistance to methicillin in infections not purely acquired from community (odds ratio = 24.92; 95% confidence interval, 9.88-62.87). The overall crude mortality rate was 21% and nearly half of the mortalities occurred within 3 days of visiting the ED. All patients discharged inadvertently were uneventful (n = 65, two lost at follow-up). Conclusions: Categories of bacteremia acquisition was associated with different distribution of pathogens, antimicrobial resistance, and clinical outcome. Traditional classification might overestimate the problem of drug resistance in community-acquired infections. The concept of health care-associated infection should be introduced to avoid overemphasis of drug-resistant problem in true community-acquired infection.

Original languageEnglish
Pages (from-to)215-221
Number of pages7
JournalJournal of Microbiology, Immunology and Infection
Volume44
Issue number3
DOIs
Publication statusPublished - Jun 2011
Externally publishedYes

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Bacteremia
Tertiary Care Centers
Hospital Emergency Service
Retrospective Studies
Community-Acquired Infections
Cross Infection
Microbiology
Taiwan
Sepsis
Epidemiology
Methicillin Resistance
Mortality
Septic Shock
Drug Resistance
Urinary Tract Infections
Observational Studies
Staphylococcus aureus
Odds Ratio
Confidence Intervals
Escherichia coli

Keywords

  • Bacteremia
  • Community-acquired
  • Emergency department
  • Health care-associated

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Infectious Diseases

Cite this

Isolated pathogens and clinical outcomes of adult bacteremia in the emergency department : A retrospective study in a tertiary Referral Center. / Kao, Chih Hsiang; Kuo, Yau Chang; Chen, Chih Chung; Chang, Yun Te; Chen, Yao Shen; Wann, Shue Ren; Liu, Yung Ching.

In: Journal of Microbiology, Immunology and Infection, Vol. 44, No. 3, 06.2011, p. 215-221.

Research output: Contribution to journalArticle

Kao, Chih Hsiang ; Kuo, Yau Chang ; Chen, Chih Chung ; Chang, Yun Te ; Chen, Yao Shen ; Wann, Shue Ren ; Liu, Yung Ching. / Isolated pathogens and clinical outcomes of adult bacteremia in the emergency department : A retrospective study in a tertiary Referral Center. In: Journal of Microbiology, Immunology and Infection. 2011 ; Vol. 44, No. 3. pp. 215-221.
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abstract = "Background: Approximately two-thirds of the patients with severe sepsis or septic shock are first encountered in the emergency departments (EDs) of western countries, in which bacteremia is present in about 50{\%} of patients with severe sepsis. The situation of bacteremia presenting to the EDs in Taiwan is not well documented. The objective of this study was to examine the epidemiology and microbiology of bacteremia in adult patients who visited the ED of a medical center in southern Taiwan. Methods: A retrospective observational study of the epidemiology and microbiology of bacteremia was conducted in the ED of a medical center involving 6,137 adult patients and 13,903 blood cultures. Results: A total of 831 consecutive patients with 890 episodes of bacteremia were obtained from January 1 to December 31, 2004, indicating a positive culture rate of 13.5{\%} (1,872/13,903). Among these episodes, 525 (59{\%}) were defined as true community-acquired infections followed by 263 (29.5{\%}) as health care-associated infections and 102 (11.5{\%}) as nosocomial infections. Of the 972 isolates, 289 (29.7{\%}) were gram-positive species and 683 (70.3{\%}) were gram-negative species. Urinary tract infections (32.2{\%}, 287/890) were most common in these patients, with Escherichia coli (30.8{\%}, 299/972) being the most common pathogen. Bacteremia caused by Staphylococcus aureus was more common in nosocomial than true community-acquired infections (31.3{\%} vs. 12{\%}) and had significantly higher possibility of resistance to methicillin in infections not purely acquired from community (odds ratio = 24.92; 95{\%} confidence interval, 9.88-62.87). The overall crude mortality rate was 21{\%} and nearly half of the mortalities occurred within 3 days of visiting the ED. All patients discharged inadvertently were uneventful (n = 65, two lost at follow-up). Conclusions: Categories of bacteremia acquisition was associated with different distribution of pathogens, antimicrobial resistance, and clinical outcome. Traditional classification might overestimate the problem of drug resistance in community-acquired infections. The concept of health care-associated infection should be introduced to avoid overemphasis of drug-resistant problem in true community-acquired infection.",
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N2 - Background: Approximately two-thirds of the patients with severe sepsis or septic shock are first encountered in the emergency departments (EDs) of western countries, in which bacteremia is present in about 50% of patients with severe sepsis. The situation of bacteremia presenting to the EDs in Taiwan is not well documented. The objective of this study was to examine the epidemiology and microbiology of bacteremia in adult patients who visited the ED of a medical center in southern Taiwan. Methods: A retrospective observational study of the epidemiology and microbiology of bacteremia was conducted in the ED of a medical center involving 6,137 adult patients and 13,903 blood cultures. Results: A total of 831 consecutive patients with 890 episodes of bacteremia were obtained from January 1 to December 31, 2004, indicating a positive culture rate of 13.5% (1,872/13,903). Among these episodes, 525 (59%) were defined as true community-acquired infections followed by 263 (29.5%) as health care-associated infections and 102 (11.5%) as nosocomial infections. Of the 972 isolates, 289 (29.7%) were gram-positive species and 683 (70.3%) were gram-negative species. Urinary tract infections (32.2%, 287/890) were most common in these patients, with Escherichia coli (30.8%, 299/972) being the most common pathogen. Bacteremia caused by Staphylococcus aureus was more common in nosocomial than true community-acquired infections (31.3% vs. 12%) and had significantly higher possibility of resistance to methicillin in infections not purely acquired from community (odds ratio = 24.92; 95% confidence interval, 9.88-62.87). The overall crude mortality rate was 21% and nearly half of the mortalities occurred within 3 days of visiting the ED. All patients discharged inadvertently were uneventful (n = 65, two lost at follow-up). Conclusions: Categories of bacteremia acquisition was associated with different distribution of pathogens, antimicrobial resistance, and clinical outcome. Traditional classification might overestimate the problem of drug resistance in community-acquired infections. The concept of health care-associated infection should be introduced to avoid overemphasis of drug-resistant problem in true community-acquired infection.

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