Comparable Outcomes in Suspected Septic Shock: A Retrospective Study of Emergency Department Patients With and...

Bacteremia is commonly present in patients with septic shock. Previous studies have found mixed associations between hospital outcomes and the presence of bacteremia in this patient population.

The primary aim of this study was to determine whether adult patients who present to the emergency department (ED) with suspected septic shock and who have bacteremia from ED-derived blood cultures have differences in outcomes. Secondary aims included the association of Gram-positive, Gram-negative, and mixed Gram-positive and Gram-negative bacteremia on hospital mortality. Finally, we sought to create a model to predict bacteremia based on ED variables.

We conducted a retrospective observational analysis at an urban academic center over a 5-year period between 2013 and 2018. Suspected septic shock was defined by the following: blood cultures collected, antibiotics administered, and vasopressors initiated in the ED. Hospital outcomes were compared in those with and without bacteremia. A logistic regression analysis was used to fit a model to best predict the presence of bacteremia based on ED variables.

We analyzed 470,558 patient encounters, and 847 were classified as suspected septic shock, meeting inclusion criteria. Two hundred forty-three (28.7%) were categorized as having bacteremia. No statistical differences were detected in univariate comparisons between patients with and without bacteremia in hospital mortality, hospital length of stay, intensive care unit length of stay, or intubation during hospitalization between those with and without bacteremia. Hospital mortality was not associated with bacteremia based on subgroup analysis by Gram stain.

Adult patients who present to the ED with suspected septic shock and have initial blood cultures that result in bacteremia experience hospital outcomes comparable with those without bacteremia.