scholarly journals Group IIA secretory phospholipase 2 independently predicts mortality and positive blood culture in emergency department sepsis patients

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Utsav Nandi ◽  
Alan E. Jones ◽  
Michael A. Puskarich
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Secretory Phospholipase

scholarly journals Risk of bacteremia in patients presenting with shaking chills and vomiting - a prospective cohort study

2020 ◽  
Vol 148 ◽  
Author(s):  
M. Holmqvist ◽  
M. Inghammar ◽  
L. I. Påhlman ◽  
J. Boyd ◽  
P. Åkesson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Vital Sign ◽  
Bacterial Infections ◽  
Altered Mental Status ◽  
Negative Blood Culture ◽  
Multivariate Logistic Regression ◽  
Prospective Multicenter Study

Abstract Chills and vomiting have traditionally been associated with severe bacterial infections and bacteremia. However, few modern studies have in a prospective way evaluated the association of these signs with bacteremia, which is the aim of this prospective, multicenter study. Patients presenting to the emergency department with at least one affected vital sign (increased respiratory rate, increased heart rate, altered mental status, decreased blood pressure or decreased oxygen saturation) were included. A total of 479 patients were prospectively enrolled. Blood cultures were obtained from 197 patients. Of the 32 patients with a positive blood culture 11 patients (34%) had experienced shaking chills compared with 23 (14%) of the 165 patients with a negative blood culture, P = 0.009. A logistic regression was fitted to show the estimated odds ratio (OR) for a positive blood culture according to shaking chills. In a univariate model shaking chills had an OR of 3.23 (95% CI 1.35–7.52) and in a multivariate model the OR was 5.9 (95% CI 2.05–17.17) for those without prior antibiotics adjusted for age, sex, and prior antibiotics. The presence of vomiting was also addressed, but neither a univariate nor a multivariate logistic regression showed any association between vomiting and bacteremia. In conclusion, among patients at the emergency department with at least one affected vital sign, shaking chills but not vomiting were associated with bacteremia.

scholarly journals Blood Culture Contamination in a Community Hospital- less than 2% is achievable

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S127-S127
Author(s):  
R Bedi ◽  
J Atkinson
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Antimicrobial Therapy ◽  
False Positive ◽  
Community Hospital ◽  
Blood Cultures ◽  
Proper Order ◽  
Multiple Devices ◽  
American Society

Abstract Introduction/Objective Blood cultures are commonly obtained to evaluate the presence of bacteria or fungal infection in a patient’s bloodstream. The presence of living microorganisms circulating in the bloodstream is of substantial prognostic and diagnostic importance. A positive blood culture indicates a reason for the patient’s illness and provides the etiological agent for antimicrobial therapy. Collection of blood culture is an exact process that requires time, the proper order of draw, and following of correct protocol. The busy Emergency department that requires multiple demands for nurse’s time, turnover of staff, rushing from one task to another can result in the improper collection and false-positive blood cultures. The national benchmark is set at 3% by the American Society of Clinical Microbiology (ASM) and The Clinical and Laboratory Standard Institute (CLSI). False-positive blood culture results in increased length of stay and unnecessary antimicrobial therapy, resulting in an increased cost burden to the hospital of about $5000 per patient. Methods/Case Report At our 150-bed community hospital, 26 beds Emergency Department, we have come a long way in reduction of our blood culture contamination rates from upwards of 4% to less than 2%, far lower than the national benchmark. Results (if a Case Study enter NA) NA Conclusion There are multiple devices available from various manufacturers claiming to reduce blood culture contamination. These devices do reduce blood culture (BC) contamination but at an added cost of the device. The rate of BC can be reduced and less than 3% is achievable by materials available in the laboratory. We have achieved this by providing training to every new staff by demonstration and direct observation, providing everything required for collection in a kit, using proper technique, the inclusion of diversion method that involves the aseptic collection of a clear tube before collecting blood cultures, and following up monthly on any false positive blood cultures.

scholarly journals LO47: Use of C-reactive protein can safely decrease the number of emergency department patients with sepsis who require blood cultures

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S44
Author(s):  
R. Stenstrom ◽  
J. Choi ◽  
E. Grafstein ◽  
T. Kawano ◽  
D. Sweet ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
False Positive ◽  
Blood Cultures ◽  
Low Risk ◽  
Reactive Protein ◽  
Emergency Department Patients ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Introduction: Sepsis protocols call for the acquisition of blood cultures in septic emergency department (ED) patients.However, the criteria for blood cultures are vague, they are costly, only positive 8-12% of the time, with up to half of these being false positives. The objective of this study was to establish if positive blood cultures could be excluded in low-risk sepsis patients with levels of CRP below 20 ml/L. Methods: This was a multicenter prospective cohort study of 765 ED patients at St Paul’s and Mount St Joseph’s hospitals in Vancouver with sepsis (2 or more SIRS criteria and infection) and none of: immuncompromised, injection drug use, indwelling vascular device or septic shock (SBP<90 mmhg). Consecutive patients with sepsis had CRP and blood cultures obtained at the same time.OUTCOMES. True positive blood cultures, false positive blood cultures, positive blood cultures that changed patient management. True and false positive blood cultures were based on Infectious Disease Society of America Guidelines, and change in management was defined as change in type or length of antibiotic therapy and was blindly adjudicated by a medical microbiologist. Results: 765 ED patients with sepsis met inclusion criteria. Mean age was 48.3 years and 57% were male. Blood cultures were positive in 99/765 (12.9%) subjects, of which 19 were false positive (19.2%). CRP was >20 mg/L in 595/765 (77.8%) of patients. Of 170 subjects with a CRP<20 mg/L, 3 had a positive blood culture (1.8%; 95% CI 0.1%- 5%). Management was not changed in any patient with a positive blood culture and CRP level<20 mg/L. Of 19 subjects with a false positive blood culture, CRP was <20 mg/L for 6 (31.6%). Conclusion: In this cohort of low-risk sepsis patients, based on a CRP of <20 mg/L, acquisition of blood cultures could be safely avoided in 22.2% of patients, at significant savings to the health care system.

scholarly journals Higher Nursing Care Level is Associated with Higher Incidence of Blood Culture Contamination in the Emergency Department: A Case-Control Study

2021 ◽  
Author(s):  
Ayami Shigeno ◽  
Yosuke Homma ◽  
Taiga Matsumoto ◽  
Shun Tanaka ◽  
Ryuta Onodera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Nursing Care ◽  
Positive Blood Culture ◽  
Case Control Study ◽  
Case Control ◽  
Blood Cultures ◽  
Case Group ◽  
Care Level ◽  
Control Study

Abstract Background Blood culture is critical in treating infectious diseases, but contamination occurs in 0.6–12.5% of all samples. This leads to unnecessary intervention, inappropriate antibiotic use, and excess cost. Few studies have tackled patient factors, such as nursing care level, that could possibly affect contamination rates. Thus, this study aimed to explore the association between patients’ nursing care levels and blood culture contamination. Methods This is a single centered, retrospective, case-control study of adult patients whose blood culture specimens were taken in the emergency department between April 2018 and July 2019. The study was conducted in a 344-bed, urban, acute care community hospital in Chiba prefecture, Japan. We included patients aged 20 years and above, with two or more sets of blood cultures. The case group included patients with false positive blood culture results with contamination; the control group included patients with true positive or true negative blood culture results without contamination. We randomly selected two control patients per case. Patients’ age, sex, nursing care level, ambulance usage, housing status, Glasgow Coma Scale, and hospital arrival time were obtained from the patients’ medical charts. Results Of the 5,130 patients, 686 patients got positive blood culture results. Of the 686 patients, 35 patients were included in the case group, and 70 were randomly selected from the non-contaminated group and included in the control. In multivariate analysis, patients with contaminated blood cultures had a higher nursing care level (odds ratio: 5.24; 95% confidence interval: 1.47 to 18.70; P = 0.02). Conclusions A higher nursing care level is associated with a higher incidence of blood culture contamination in the emergency department. Careful and appropriate procedures are required for patients with a higher nursing care level.

scholarly journals Clinical factors associated with bloodstream infection at the emergency department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pariwat Phungoen ◽  
Nunchalit Lerdprawat ◽  
Kittisak Sawanyawisuth ◽  
Verajit Chotmongkol ◽  
Kamonwon Ienghong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Bloodstream Infection ◽  
Positive Blood Culture ◽  
Clinical Judgment ◽  
Solid Organ ◽  
Clinical Factors ◽  
Suspected Infection ◽  
Intravenous Antibiotics ◽  
History Of

Abstract Background Bloodstream infection (BSI) is a common urgent condition at the emergency department (ED). However, current guidelines for diagnosis do not specify the juncture at which blood cultures should be taken. The decision whether or not to obtain hemoculture is based solely upon clinical judgment and potential outcomes of inappropriately ordered cultures. This study aimed to find clinical factors present on ED arrival that are predictive of bloodstream infection. Methods This study was conducted retrospectively at the ED of a single tertiary care hospital in Thailand. We included adult patients with suspected infection based on blood culture who were treated with intravenous antibiotics during their ED visit. Independent positive predictors for positive blood culture were calculated by logistic regression analysis. Results A total of 169,578 patients visited the ED during the study period, 12,556 (7.40%) of whom were suspected of infection. Of those, 8177 met the study criteria and were categorized according to blood culture results (741 positive; 9.06%). Six clinical factors, including age over 55 years, moderate to severe CKD, solid organ tumor, liver disease, history of chills, and body temperature of over 38.3 °C, were associated with positive blood culture. Conclusions Clinical factors at ED arrival can be used as predictors of bloodstream infection.

scholarly journals Quick BSI Score to Identify Bloodstream Infection at the Emergency Department

2020 ◽  
Author(s):  
Pariwat Phungoen ◽  
Nunchalit Lerdprawat ◽  
Kittisak Sawanyawisuth ◽  
Verajit Chotmongkol ◽  
Kamonwon Ienghong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Negative Predictive Value ◽  
Bloodstream Infection ◽  
Positive Blood Culture ◽  
Clinical Judgment ◽  
Predictive Value ◽  
University Hospital ◽  
Solid Organ ◽  
Current Guideline

Abstract Background Bloodstream infection (BSI) is a common and urgent condition at the emergency department (ED). In order to diagnose BSI, the current guideline fails to mention the juncture at which blood cultures ought to be taken. The decision whether or not to obtain hemoculture is solely based upon clinical judgment and outcomes pertaining to inappropriately ordered blood culture. This study aimed to develop predictive bloodstream infection scoring at the ED employing only clinical factors presented on ED arrival. Methods This study was conducted retrospectively at the ED, Khon Kaen University Hospital, Thailand. Inclusion criteria encompassed adult patients suspected of infection defined by blood culture collection presented at the ED with intravenous antibiotics initiated during ED visits. Independent positive predictors for positive blood culture were used to create the Quick Bloodstream Infection score (qBSI score) through logistic regression analysis. Results A total of 169578 patients visited the ED during the study period. Of those, 12556 patients (7.40%) were suspected of infection. 8177 cases met the study criteria and were categorized according to positive blood culture results, i.e. bloodstream infection (741 patients; 9.06%). Probability of positive blood culture was calculated via aged over 55 years + moderate to severe CKD + solid organ tumor + (2 x liver disease) + (2 x history of fever with chills) + (2 x body temperature of over 38.3 o C). A score of 1 or over rendered 92.98% sensitivity and negative predictive value of 95.65%. Conclusions The qBSI score presented effective sensitivity and negative predictive value amid positive blood culture in patients at the ED suspected of infection. Resultant of employing this score may facilitate in the determining of those exhibiting the need for blood culture at the ED.

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