Predictive factors of bacteraemia in the patients seen in emergency departments due to infections

Abstract

Objectives. The aim of the study was to analyze predictive factors of bacteraemia in patients seen in the emergency department (ED) for an episode of infectious disease. Patients and methods. Observational, retrospective and descriptive analytical study of all blood cultures extracted in an ED in adult patients (≥ 18 years) seen in ED due to infectious disease from 1-1-2019 to 1-7-2019. The follow-up was carried out during 30 days. Thirty-eight variables for predicting bacteraemia were assessed. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Univariate and multivariate logistic regression analysis was performed. Results. A total of 1,425 blood cultures were finally enrolled in the study. Of those were considered true bacteremia 179 (12.6 %) and as negative blood cultures 1,246 (87.4 %). Amongst negatives, 1,130 (79.3%) without growth and 116 (8.1%) as contaminants blood cultures. Five variables were significantly associated with true bacteraemia: serum procalcitonin (PCT)

Models for bacteraemia risk prediction. Clinical implications

“…These include inflammatory response and infection biomarkers (BM) that increase the predictive power of clinical models [25][26][27][28]. Between all BM, procalcitonin (PCT) has been found to be the most sensitive and specific to predict bacteraemia risk [22,[3][4][5][6], with a high negative predictive value (NPV) that would rule out a TB [29].…”

“…The risk calculation can be done online through the following link: https://mpbscore.urgenciasclinico.com Usefulness of biomarkers for the prediction of true bacteraemia risk. Several studies have investigated the power of different BM to identify the patient with TB [3][4][5][6]. Among them, the literature clearly shows that PCT is the BM that presents a greater diagnostic accuracy.…”

“…Bacteraemia has an increasing incidence of up to 1-2 cases/1,000 treatments in hospital emergency departments (ED) and around 6-10 episodes/1,000 hospital admissions [1][2][3]. When an infectious disease is suspected, blood cultures (BC) are taken in 15% of all microbiological samples obtained [4].…”

Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department

“…La sospecha y confirmación de BV tiene un relevante significado diagnóstico, pronóstico y obliga a cambiar algunas de las decisiones a tomar en el SUH (indicar el alta o ingreso, extraer HC y administrar el antimicrobiano adecuado y precoz) [10]. Distintos factores predictivos de BV se han publicado en los últimos años, pero son pocos los evaluados específicamente en pacientes con NAC [11][12][13][14]. Recientemente, se ha publicado un nuevo modelo predictivo de bacteriemia (5MPB-Toledo) que consigue un área bajo la curva de la característica operativa del receptor(ABC-COR) de 0,946 (IC 95%:0,922-0,969) [15].…”

“…En estos, la sospecha de bacteriemia tiene un importante significado diagnóstico y pronóstico. Pero, además, los HC también se obtienen en el SUH como garantía de continuidad asistencial, ya que del conocimiento de sus resultados dependerá el manejo y evolución posterior del paciente en su destino final[7,11].En este escenario, se ha acentuado el estudio de los factores predictores de bacteriemia y se han propuesto distintos modelos predictivos para los SUH de distinta complejidad[12- 15]. En ellos, ha adquirido una gran relevancia el papel que pueden jugar los biomarcadores, y en especial la PCT[17,18], como factores predictores independientes de bacteriemia.…”