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Blood cultures of adult patients discharged from the emergency department—is the safety net reliable?

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Abstract

We investigated the clinical implications of the practice in our emergency department (ED) of discharging patients with pending blood cultures. We reviewed the medical records of adults discharged with positive blood cultures from the ED of a 330-bed university hospital during a five-year period. Clinical characteristics, laboratory data, and antibiotic treatment prescribed in the ED and at discharge were accessed. Antimicrobial susceptibility profiles were used to determine whether antibiotic treatment was adequate. The outcomes assessed for 90 days following discharge were return to the ED, hospitalization, modified diagnosis, and death. Of 220,681 visits to the ED, 1362 showed positive blood cultures; of these, 307 (22.5%) were from discharged patients. More than half the isolates (56.3%) were considered contaminants. Of 124 visits with true bacteremia, Enterobacteriaceae were the most common pathogens (67.0%). This is concordant with urinary tract infection (UTI) being the most common diagnosis (52.4%). With antibiotic treatment, 69.4% had been discharged with antibiotic treatment, which was adequate in two-thirds of them. Among the 77 who returned to the ED, 27.5% had persistent bacteremia. The diagnosis was changed in 44.2% of them, mostly with brucellosis or bone and joint infections, and 84.4% were subsequently hospitalized. Within three months, 5.6% of bacteremic patients died, all after hospitalization. Bacteremia in discharged patients occurred mainly in association with UTI. Outcomes were generally favorable, although only about half received appropriate antibiotic treatment. Diagnoses were changed in a relatively high proportion of patients following culture results.

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Abbreviations

CT:

computer tomography

ED:

emergency department

WBC:

white blood count.

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Author information

Correspondence to Sarah Israel.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local Institutional Review Board.

Informed consent

The requirement for informed consent was waived since the study was based on anonymized data collected retrospectively.

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Meetings

The work was presented as an oral presentation at the ECCMID (European Congress of Clinical Microbiology & Infectious Diseases) in Amsterdam, Netherlands, on April 16th 2019. It was also presented as an oral presentation at the annual meeting of the Israel Emergency Medicine Society in Tel Aviv, Israel, March 2019; and was awarded the best poster at the annual meeting of the Israel Infectious Diseases Society in Kfar Blum, Israel, May 2019. It was presented as well as an oral presentation at the MEMC19 (Mediterranean Emergency Medicine Congress) in Dubrovnik, Croatia, September 2019.

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Kenig, A., Salameh, S., Gershinsky, Y. et al. Blood cultures of adult patients discharged from the emergency department—is the safety net reliable?. Eur J Clin Microbiol Infect Dis (2020). https://doi.org/10.1007/s10096-020-03838-3

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Keywords

  • Bloodstream infection
  • Blood cultures
  • Emergency department
  • Clinical practice