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Epidemiology and outcomes of bloodstream infections in patients discharged from the emergency department

Published online by Cambridge University Press:  11 February 2015

Justine Chan ,
Jenna Wong ,
Raphael Saginur ,
Alan J. Forster  and
Carl van Walraven
Justine Chan
Affiliation:
Faculty of Medicine, University of Ottawa, Ottawa, ON;
Jenna Wong
Affiliation:
Epidemiology, Biostatistics and Occupation Health, McGill University, Montreal, QC;
Raphael Saginur
Affiliation:
Faculty of Medicine, University of Ottawa, Ottawa, ON; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON ICES, University of Ottawa, Ottawa, ON.
Alan J. Forster
Affiliation:
Faculty of Medicine, University of Ottawa, Ottawa, ON; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON ICES, University of Ottawa, Ottawa, ON.
Carl van Walraven*
Affiliation:
Faculty of Medicine, University of Ottawa, Ottawa, ON; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON ICES, University of Ottawa, Ottawa, ON.
*
Correspondence to: Dr. Carl van Walraven, ASB1-003, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; carlv@ohri.ca

Abstract

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Objective

To determine the outcomes of patients discharged from the emergency department (ED) with a bloodstream infection (BSI) and how these outcomes are influenced by antibiotic treatment.

Method

We identified every BSI in adult patients discharged from our ED to the community between July 1, 2002, and March 31, 2011. The medical records of all cases were reviewed to determine antibiotic treatment in the ED and at discharge. Microorganism sensitivities were used to determine whether antibiotics were appropriate. These data were linked to population-based administrative data to determine specific patient outcomes within the subsequent 2-week period: death, urgent hospitalization, or an unplanned return to the ED.

Results

A total of 480 adults with BSI were identified (1.49 cases per 1,000 adults discharged from the department). Compared to controls (321,048 patients), BSI patients had a significantly higher risk of urgent hospitalization (adjusted OR 2.1 [95% CI 1.6–2.8]) and unplanned return to the ED (adjusted OR 4.1 [95% CI 3.3–4.9]). Outcome risk was significantly lowered in BSI patients who received appropriate antibiotics in the ED and at discharge. In elderly patients, the risk of urgent hospitalization increased significantly as the time to appropriate antibiotics was delayed.

Conclusions

BSI patients discharged from the ED have a significantly increased risk of urgent hospitalization and unplanned return to the ED in the subsequent 2 weeks. These risks decrease significantly with the timely provision of appropriate antibiotics. Our results support the aggressive use of measures ensuring that such patients receive appropriate antibiotics as soon as possible.

Résumé

Objectif

L’étude visait à déterminer les résultats cliniques chez des patients souffrant d’une infection hématogéne (IH) et renvoyés du service des urgences (SU) et la façon dont le traitement antibiotique influait sur ces résultats.

Méthode

Nous avons procédé à la recherche de tous les cas d’IH observés chez des adultes qui avaient été renvoyés du SU dans la collectivité, entre le 1er juillet 2002 et le 31 mars 2011. Les dossiers médicaux de tous les patients ont été revus afin que soit déterminé le traitement antibiotique prescrit au SU et au moment du congé. La pertinence des antibiotiques prescrits a été établie en fonction de la sensibilité des micro-organismes. Les données recueillies ont été liées à des données administratives fondées sur la population pour permettre de dégager certains résultats cliniques au cours des 2 semaines suivantes: la mort, une hospitalisation urgente, ou un retour imprévu au SU.

Résultats

Au total, 480 adultes souffrant d’une IH ont ainsi été trouvés (1.49 cas pour 1,000 adultes renvoyés du service). Les patients atteints d’une IH avaient un risque significativement plus élevé d’hospitalisation urgente (risque relatif approché [RRA] rajusté: 2.1 [IC à 95%: 1.6–2.8]) et de retour imprévu au SU (RRA rajusté: 4.1 [IC à 95%: 3.3–4.9]) que les témoins (321,048 patients). Toutefois, les risques liés aux résultats étaient significativement diminués chez les patients atteints d’une IH qui avaient reçu un traitement antibiotique approprié au SU et au moment du congé. Chez les personnes âgées, le risque d’hospitalisation urgente augmentait sensiblement à mesure qu’était retardée la mise en route d’un traitement antibiotique approprié.

Conclusions

Les patients atteints d’une IH et renvoyés à domicile depuis le SU connaissent un risque significativement accru d’hospitalisation urgente et de retour imprévu au SU au cours des 2 semaines suivantes. Toutefois, l’administration rapide d’antibiotiques appropriés permet de diminuer sensiblement ce risque. Les résultats confirment la pertinence de mesures énergiques visant l’administration la plus rapide possible d’antibiotiques appropriés chez ces patients.

Keywords

administrative databloodstream infectionsemergency departmentoutcomes
Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 1 , January 2015 , pp. 27 - 37
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

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