Ramos J M, Masiá M, Elía M, Gutiérrez F, Royo G, Bonilla F, Padilla S, Martín-Hidalgo A
Department of Internal Medicine, Hospital General Universitario de Elche, Alicante, Spain.
Eur J Clin Microbiol Infect Dis. 2004 Dec;23(12):881-7. doi: 10.1007/s10096-004-1235-0.
A prospective study was carried out to analyze the usefulness of blood culture results for adult patients who were discharged from the emergency department with bacteremia. Over a 29-month period, 110 patients with significant bacteremia who were seen in the emergency department and discharged home were studied. The mean age of the patients was 61.8 years. The most frequent initial major diagnosis was urinary tract infection (UTI) (n=63; 57.3%). Gram-negative organisms were isolated in 79 (71.8%) cases. A change in diagnosis (44.5% cases) was more common when the initial diagnosis was something other than UTI or when empiric antimicrobial therapy was ineffective or was not given (P<0.001). The significant predictors of modification of the initial empiric antibiotic therapy were ineffective empiric antimicrobial therapy and transfer of the patient from the emergency department to an infectious diseases outpatient clinic (P=0.01). Blood culture results may be useful for achieving the correct diagnosis in adult patients with bacteremia and for guiding treatment in the subsequent management of outpatients.
开展了一项前瞻性研究，以分析血培养结果对因菌血症从急诊科出院的成年患者的有用性。在29个月的时间里，对110例在急诊科就诊并出院回家的严重菌血症患者进行了研究。患者的平均年龄为61.8岁。最常见的初始主要诊断是尿路感染（UTI）（n = 63；57.3%）。79例（71.8%）分离出革兰氏阴性菌。当初始诊断不是UTI、经验性抗菌治疗无效或未给予时，诊断改变（44.5%的病例）更为常见（P<0.001）。初始经验性抗生素治疗调整的显著预测因素是经验性抗菌治疗无效以及患者从急诊科转到传染病门诊（P = 0.01）。血培养结果可能有助于对成年菌血症患者做出正确诊断，并指导门诊患者后续治疗的管理。
