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Characteristics and outcomes of polymicrobial bloodstream infections in the emergency department: A matched
Jiun-Nong Lin1, Chung-Hsu Lai, Yen-Hsu Chen
1Department of Emergency Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taipei, Taiwan.
Objectives:
Polymicrobial bloodstream infection (BSI) is a critical condition and has been increasingly reported; however, the authors were unable to find an emergency department (ED) patient-based study in the literature.
Methods:
A retrospective matched case-control study with a ratio of 1:3 among patients with polymicrobial BSIs in an ED was conducted. The case group was patients aged > 16 years with polymicrobial BSIs. Patients matched for age and sex with monomicrobial BSIs were sampled as the control group. Demographic information, underlying conditions, microbiologic data, and outcomes were collected for further analysis.
Results:
From January 2005 to December 2007, a total of 112 episodes of polymicrobial BSIs among 109 patients were included. Two pathogens were isolated among 87 (77.7%) episodes and three were found among 25 (22.3%) episodes. A history of hospitalization within 90 days was an independent risk factor for polymicrobial BSIs (p = 0.003). Intraabdominal infection (p < 0.001) and respiratory tract infection (p = 0.017) were more likely to be associated with polymicrobial BSIs. Gram-negative and Gram-positive bacteria were documented in 95.5 and 46.4% episodes of polymicrobial BSIs, respectively. Inappropriate antimicrobial treatment was observed in 53.6% of polymicrobial BSIs, but only accounted for 23.8% of monomicrobial BSIs (p < 0.001). The overall 30-day mortality rate of the polymicrobial group was significantly higher than those with monomicrobial BSIs (30.3 and 11.6%, respectively; p < 0.001).
Conclusions:
Patients with polymicrobial BSIs had a high mortality rate. Acknowledgment of the clinical and microbiologic characteristics and recognition of patients at risk for polymicrobial BSIs are critical in EDs.
Insights
Polymicrobial bloodstream infections (BSIs) in the emergency department (ED) are linked to higher mortality rates. Identifying at-risk patients and understanding infection characteristics are crucial for effective management.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Polymicrobial bloodstream infections (BSIs) are increasingly reported but lack emergency department (ED) patient-based studies.
- Understanding the specific characteristics of polymicrobial BSIs in the ED is essential for timely and appropriate patient care.
Purpose of the Study:
- To investigate the clinical and microbiologic features of polymicrobial BSIs in an emergency department (ED) setting.
- To identify risk factors and outcomes associated with polymicrobial BSIs compared to monomicrobial BSIs.
Main Methods:
- Retrospective matched case-control study (1:3 ratio) of patients with polymicrobial BSIs in the ED.
- Cases were patients >16 years with polymicrobial BSIs; controls were matched for age and sex with monomicrobial BSIs.
- Data collected included demographics, comorbidities, microbiology, and patient outcomes.
Main Results:
- 112 episodes of polymicrobial BSIs were analyzed; 90-day hospitalization was a risk factor.
- Intra-abdominal and respiratory tract infections were more common in polymicrobial BSIs.
- Inappropriate antimicrobial treatment (53.6%) and 30-day mortality (30.3%) were significantly higher in polymicrobial BSIs versus monomicrobial BSIs (11.6%).
Conclusions:
- Polymicrobial BSIs in the ED are associated with a high mortality rate.
- Recognizing clinical and microbiologic patterns and identifying at-risk patients are critical for managing polymicrobial BSIs in the ED.
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