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The following is a summary of “Strategies to reduce 28-day mortality in adult patients with bacteremia in the emergency department,” published in the December 2024 issue of Infectious Disease by Laurier et al.
Researchers conducted a retrospective study to identify areas for potential improvement in the management of bacteremia in the emergency department.
They included adults with bacteremia in an emergency department in 2019 and 2022. The primary outcome assessed was 28-day mortality. Descriptive analyses were performed to examine demographics, comorbidities, and clinical characteristics. Univariate and multivariate analyses were employed to identify predictors of mortality.
The results showed 433 patients were included, with 217 males (50.1%) and a mean age of 74.1 ± 15.2 years. The 28-day mortality rate was 15.2% (n = 66). Univariate analysis identified several factors significantly associated with mortality, including age ≥ 70 years, ambulance arrival, arrhythmia, congestive heart failure, recent steroid use, hypotension (< 90/60 mmHg), mechanical ventilation, cardiac arrest, intensive care unit (ICU) admission, intravenous antibiotics, pneumonia as the bacteremia source, non-urinary tract infections, no infectious disease consultation, no antibiotic adjustment, and no control blood cultures (P < 0.05). Malignancy showed a statistical trend (0.05 < P < 0.15). Multivariate analysis revealed 5 significant risk factors for mortality: ICU admission [adjusted OR (95% CI): 6.03 (3.08–11.81)], pneumonia as the bacteremia source [4.94 (2.62–9.32)], age ≥ 70 years [3.16 (1.39–7.17)], hypotension [2.12 (1.02–4.40)], and no infectious disease consultation [2.02 (1.08–3.78)]. Initial antibiotic administration within 6 hours, inappropriate antibiotic regimens, and bacterial type (Gram-negative, Gram-positive) were not significant (P > 0.05).
Investigators concluded the referral to an infectious disease physician was the only modifiable strategy identified to decrease 28-day mortality with long-term effects and should be prioritized.
Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-10242-1
