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

English version

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
prolekare.web.journal.doi_sk: 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:

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

Zdroje

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

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