Abstract
Background
Community-onset blood stream infection (C-BSI) is an important cause of sepsis. The urinary tract is an important source for C-BSI. Urinary catheters are a recognized risk factor. Blood culture is the critical diagnostic test. Prompt effective antimicrobial therapy is a key intervention. We reviewed practice in relation to patients presenting with suspected C-BSI.
Aim
To review practice in relation to patients presenting with suspected C-BSI.
Methods
Patients were those with blood cultures (BC) submitted from the emergency department over 4 weeks. Details were recorded from laboratory and patient records. Data were analysed in SPSS.
Results
BC were taken from 201 patients. Suspected source was respiratory (32.8%), urine (14.9%) or other (52.3%). 9 (4.5%) patients had urine catheters. Urine was the suspected source of infection in five of these. Bacteriuria was present in seven of these nine from whom urine samples were submitted though it was polymicrobial in all but 2. Median time from registration to first administration of an antimicrobial was 226 min and was broadly guideline compliant in 121 (80.7%) of 151 patients who received treatment. BC were positive in 17 (8.5%) of which 10 (5.0%) were significant (mainly Escherichia coli).
Conclusions
Suspected C-BSI is common. E. coli is the leading pathogen. Urine is a common suspect source. Urinary catheters are present in 4.5%. Median time to first dose of antimicrobial treatment is almost 4 h suggesting scope to expedite patients transition from presentation to intervention.
References
National Clinical Effectiveness Committee (2014) Sepsis Management: National Clinical Guideline No. 6. Department of Health. http://www.hse.ie/eng/about/Who/clinical/natclinprog/sepsis/sepsis%20management.pdf. Accessed 1 Aug 2016
Laupland KB, Church DL (2014) Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev 27:647–664. doi:10.1128/CMR.00002-14
Rodriguez-Bano J, Lopez-Prieto MD, Portillo MM et al (2009) Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect 16:1408–1413. doi:10.1111/j.1469-0691.2010.03089.x
Bahagon Y, Raveh D, Schlesinger Y et al (2007) Prevalence and predictive features of bacteraemic urinary tract infection in emergency department patients. Eur J Clin Microbiol Infect Dis 26:349–352. doi:10.1007/s10096-007-0287-3
Health Protection Surveillance Centre (2005) European Antimicrobial Resistance Surveillance System (EARSS) Quarter 1, 2005, June 2005. Health Protection Surveillance Centre http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2005Reports/File,1172,en.pdf. Accessed 6 Sept 2016
Health Protection Surveillance Centre (2005) European Antimicrobial Resistance Surveillance System (EARSS) Quarter 2, 2005, September 2005. Health Protection Surveillance Centre. http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2005Reports/File,1354,en.pdf. Accessed 6 Sept 2016
Health Protection Surveillance Centre (2005) European Antimicrobial Resistance Surveillance System (EARSS) Quarter 3, 2005, December 2005. Health Protection Surveillance Centre http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2005Reports/File,1427,en.pdf. Accessed 6 Sept 2016
Health Protection Surveillance Centre (2005) European Antimicrobial Resistance Surveillance System (EARSS) Quarter 4, 2005, March 2006. Health Protection Surveillance Centre. http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2005Reports/File,1516,en.pdf. Accessed 6 Sept 2016
Health Protection Surveillance Centre (2005). EARSS-Net Report Quarter 1–4, 2015, April 2016. Health Protection Surveillance Centre. http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2015Reports/File,15214,en.pdf. Accessed 6 Sept 2016
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was funded by the National University of Ireland, Galway.
Conflict of interest
Mr. Reza declares no conflict of interest. Professor Cormican has received speaker’s fees and advisory board fees from MDS outside of the submitted work.
Ethical approval
This article does not contain any studies with animals or humans performed by any of the authors.
Rights and permissions
About this article
Cite this article
Reza, M.A., Cormican, M. Audit of aspects of practice in relation to patients with suspected community-onset blood stream infection. Ir J Med Sci 186, 999–1001 (2017). https://doi.org/10.1007/s11845-017-1588-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-017-1588-x