Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study


Autoři: Kathrin Rothe aff001;  Christoph D. Spinner aff002;  Armin Ott aff003;  Christiane Querbach aff004;  Michael Dommasch aff005;  Cassandra Aldrich aff006;  Friedemann Gebhardt aff001;  Jochen Schneider aff002;  Roland M. Schmid aff002;  Dirk H. Busch aff001;  Juri Katchanov aff002
Působiště autorů: Technical University of Munich, School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Munich, Germany aff001;  Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Department of Medicine II, Munich, Germany aff002;  Technical University of Munich, Institute of Medical Informatics, Statistics, and Epidemiology, Munich, Germany aff003;  Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Pharmacy Department, Munich, Germany aff004;  Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Department of Medicine I, Munich, Germany aff005;  Ludwigs-Maximilians-University Munich, Division of Infectious Diseases and Tropical Medicine, Munich, Germany aff006;  German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany aff007
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222545

Souhrn

Bloodstream infections (BSI) are associated with high mortality. Therefore, reliable methods of detection are of paramount importance. Efficient strategies to improve diagnostic yield of bacteraemia within the emergency department (ED) are needed. We conducted a retrospective analysis of all ED encounters in a high-volume, city-centre university hospital within Germany during a five-year study period from October 2013 to September 2018. A time-series analysis was conducted for all ED encounters in which blood cultures (BCs) were collected. BC detection rates and diagnostic yield of community-onset bacteraemia were compared during the study period (which included 45 months prior to the start of a new diagnostic Antibiotic Stewardship (ABS) bundle and 15 months following its implementation). BCs were obtained from 5,191 out of 66,879 ED admissions (7.8%). Bacteraemia was detected in 1,013 encounters (19.5% of encounters where BCs were obtained). The overall yield of true bacteraemia (defined as yielding clinically relevant pathogens) was 14.4%. The new ABS-related diagnostic protocol resulted in an increased number of hospitalised patients with BCs collected in the ED (18% compared to 12.3%) and a significant increase in patients with two or more BC sets taken (59% compared to 25.4%), which resulted in an improved detection rate of true bacteraemia (2.5% versus 1.8% of hospital admissions) without any decrease in diagnostic yield. This simultaneous increase in BC rates without degradation of yield was a valuable finding that indicated success of this strategy. Thus, implementation of the new diagnostic ABS bundle within the ED, which included the presence of a skilled infectious disease (ID) team focused on obtaining BCs, appeared to be a valuable tool for the accurate and timely detection of community-onset bacteraemia.

Klíčová slova:

Medicine and health sciences – Diagnostic medicine – Critical care and emergency medicine – Pathology and laboratory medicine – Pathogens – Health care – Health care providers – Medical doctors – Physicians – Pulmonology – Respiratory infections – Biology and life sciences – Microbiology – Medical microbiology – Microbial pathogens – Bacterial pathogens – Pseudomonas aeruginosa – Escherichia coli – Organisms – Bacteria – Pseudomonas – Enterobacteriaceae – Escherichia – Gut bacteria – Anatomy – Body fluids – Blood – Physiology – People and places – Population groupings – Professions – Medical personnel – Research and analysis methods – Animal studies – Experimental organism systems – Model organisms – Prokaryotic models – Physical sciences – Materials science – Materials – Contaminants


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