Patients with bacteremia dying before notification of positive blood cultures: a 3-year clinical study

In a 3-year prospective survey of bacteremia in a Danish county, 102 patients (4.6%) died before notification of positive blood cultures. Clinical records were available for 99 patients (ED group) with a male/female ratio of 1.15 and a median age of 74 years. The predominant pathogens were Escherichia coli (32%), Streptococcus pneumoniae (17%) and Staphylococcus aureus (16%). Streptococcus pneumoniae was the only pathogen found to be more frequently in the ED group than among patients who were alive when notification was issued (ALIVE group) (17% vs 10%). All but 2 patients with meningococcal disease had a predisposing condition. Infection was deemed to be the direct cause of death in 62%, a contributory factor in 31% and of marginal significance in 6%. Compared with the ALIVE group, the ED group was older and more frequently had a focus within the respiratory tract. Conversely, the urogenital tract and intravascular devices were less common foci. The detection time was similar for the ED and ALIVE groups (median 22 and 24 h, respectively). 78% of ED patients had received antibiotic therapy and the coverage was appropriate in 59%. The possibility of bacteremia had not been responded to by institution of antibiotic therapy in the remaining patients. We conclude that physicians must consider antibiotic therapy when ordering sampling of blood for culture and empirical antibiotic therapy should basically provide coverage for pneumococci, S. aureus and E. coli.