Likelihood of Bacterial Infection in Patients Treated with Broad-Spectrum Intravenous Antibiotics in the Emergency Department

Details

• Alternative Title:
  Crit Care Med
• Personal Author:
  Shappell, Claire N. ; Klompas, Michael ; Ochoa, Aileen ; Rhee, Chanu
• Corporate Authors:
  CDC Prevention Epicenters Program
• Description:
  Objectives
  
  Best practice guidelines and quality metrics recommend immediate antibiotic treatment for all patients with suspected sepsis. However, little is known about how many patients given intravenous antibiotics in the Emergency Department (ED) are ultimately confirmed to have bacterial infection.
  
  Design, Setting, and Patients
  
  We performed a retrospective study of adult patients who presented to four Massachusetts EDs between June 2015 and June 2018 with suspected serious bacterial infection, defined as blood cultures drawn and broad-spectrum intravenous antibiotics administered. Structured medical record reviews were performed on a random sample of 300 cases to determine the post-hoc likelihood of bacterial infection, categorized as definite, likely, unlikely, or definitely none.
  
  Interventions
  
  None
  
  Measurements and Main Results
  
  Among the 300 patients with suspected serious bacterial infections, mean age was 68 years (SD 18), median hospital length-of-stay was 5 days (IQR 3–8), 45 (15%) were admitted directly to ICU, and 14 (5%) died in hospital. Overall, 196 (65%) had definite (n=115, 38%) or likely (n=81, 27%) bacterial infection, while 104 (35%) were unlikely (n=55, 18%) or definitely not infected (n=49, 16%). Antibiotic treatment durations differed by likelihood of infection (median 15 days for definite, 9 for likely, 7 for unlikely, and 3 for definitely not infected). The most frequent post-hoc diagnoses in patients with unlikely or definitely no bacterial infection included viral infections (28%), volume overload or cardiac disease (9%), drug effects (9%) and hypovolemia (7%). The likelihoods of infection were similar in the subset of 96 cases in whom ED providers explicitly documented possible or suspected sepsis and in the 45 patients admitted from the ED to the ICU.
  
  Conclusions
  
  One third of patients empirically treated with broad-spectrum antibiotics in the ED are ultimately diagnosed with non-infectious or viral conditions. These findings underscore the difficulty diagnosing serious infections in the ED and have important implications for guidelines and quality measures that compel immediate empiric antibiotics for all patients with possible sepsis.
  
  
• Subjects:
  Adult Aged Anti-Bacterial Agents Bacterial Infections Emergency Service, Hospital Female Humans Intensive Care Units Male Massachusetts Middle Aged Retrospective Studies Sepsis

  More +
• Keywords:
  Antibiotics Likelihood Of Infection Serious Infections
• Source:
  Crit Care Med. 49(11):e1144-e1150
• Pubmed ID:
  33967206
• Pubmed Central ID:
  PMC8516665
• Document Type:
  Journal Article
• Funding:
  T32 HL007633/HL/NHLBI NIH HHSUnited States/ ; U54 CK000484/CK/NCEZID CDC HHSUnited States/ ; U54CK000484/ACL/ACL HHSUnited States/
• Volume:
  49
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:062f6c06d48b525ffcb7da6a3780907be2dad33b57ffca52138ee3093d748a71
• Download URL:
  https://stacks.cdc.gov/view/cdc/158052/cdc_158052_DS1.pdf
• File Type:
  [PDF - 128.20 KB ]