Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Am J Emerg Med. 2012 Jul;30(6):839-45. doi: 10.1016/j.ajem.2011.05.026. Epub 2011 Dec 12.
This study aims to determine the risk factors associated with the bacterial contamination of blood cultures among adults visiting the emergency department (ED).
Clinical variables and medical records of adults with bacterial growth of blood cultures in the ED as well as the degree of ED crowding, between August 2007 and July 2008, were prospectively collected.
Of the 11 491 adults who underwent blood culture sampling, the medical records of 558 (4.86%) eligible patients with bacterial growth in their blood cultures were analyzed. Most patients (366, or 3.19%) had true bacteremia, whereas 192 (1.67%) were regarded as contaminated. In multivariate analyses, ED overcrowding (scoring was based on a National Emergency Department Overcrowding Study [NEDOCS] score ≥ 100 points) was independently associated with blood culture contamination (odds ratio [OR], 1.58; P = .04). In contrast, other medical comorbidities, such as liver cirrhosis (OR, 0.31; P = .02), thrombocytopenia (<100 000/mm(3); OR, 0.28; P = .002), or high serum levels of C-reactive protein (>100 mg/L; OR, 0.24; P < .001), were negatively associated with blood culture contamination. On further analysis of the 5 crowding categories as stratified by NEDOCS scores, which included not busy and busy (0-60 points), extremely busy but not overcrowded (60-100), overcrowded (100-140), severely overcrowded (140-180), and dangerously overcrowded (180-200), there was a strong correlation between blood culture contamination rates and the degrees of ED crowding (γ = 0.99, P < .001).
Emergency department overcrowding may have an adverse impact on the quality of clinical care, including increasing the risk of blood culture contamination.
本研究旨在确定与成人急诊（ED）血培养细菌污染相关的危险因素。
2007 年 8 月至 2008 年 7 月，前瞻性收集 ED 中血培养有细菌生长的成人的临床变量和病历，以及 ED 拥挤程度。
在接受血培养采样的 11491 名成人中，分析了 558 名（4.86%）血培养细菌生长的合格患者的病历。大多数患者（366 例，3.19%）有真正的菌血症，而 192 例（1.67%）被认为是污染菌。多变量分析显示，ED 过度拥挤（评分基于国家急诊拥挤研究[NEDOCS]评分≥100 分）与血培养污染独立相关（比值比[OR]，1.58；P=0.04）。相比之下，其他医疗合并症，如肝硬化（OR，0.31；P=0.02）、血小板减少症（<100000/mm3；OR，0.28；P=0.002）或高血清 C 反应蛋白水平（>100mg/L；OR，0.24；P<.001），与血培养污染呈负相关。在进一步分析 NEDOCS 评分分层的 5 个拥挤类别时，包括不忙和忙（0-60 分）、非常忙但不拥挤（60-100 分）、拥挤（100-140 分）、严重拥挤（140-180 分）和极度拥挤（180-200 分），血培养污染率与 ED 拥挤程度之间存在很强的相关性（γ=0.99，P<.001）。
ED 过度拥挤可能对临床护理质量产生不利影响，包括增加血培养污染的风险。
