Clinical impact of Gram-negative nonfermenters on adults with community-onset bacteremia in the emergency department

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Abstract

Background: To determine clinical predictors and impact of Gram-negative nonfermenters (GNNFs) infections among adults with community-onset bacteremia in the emergency department (ED). Methods: Adults with bacteremia visiting the ED from January 2007 to June 2008 were identified retrospectively. Demographic characteristics, underlying illnesses, clinical conditions, bacteremic pathogens, antimicrobial agents, and outcome, were retrieved from chart records. Results: After the exclusion of 261 patients with contamination of blood cultures and 24 patients referred from other hospitals, 518 adults with community-onset bacteremia were eligible; their mean age was 65.1 years, with slight predominance of female (262 patients, 50.6%). Of a total of 565 bacteremic isolates, Escherichia coli (228 isolates, 40.4%) and Klebsiella pneumoniae (100, 17.7%) were the major microorganisms. GNNFs caused bacteremia in 31 (6.0%) patients. A higher proportion of inappropriate antibiotic therapy in the ED (87.1% vs. 26.5%, p<0.001) and higher 28-day crude mortality rate (19.4% vs. 8.4%, p=0.05) were observed in bacteremic patients caused by GNNFs than those not caused by GNNFs. In further analysis of Kaplan-Meier survival curve, patients with GNNF bacteremia had a worse outcome than those due to other pathogens ( p=0.04). Multivariate analysis revealed that the independent predictors related to GNNF bacteremia included surgery during previous 4 weeks prior to ED arrival [odds ratio (OR), 10.79; 95% confidence interval (CI), 1.84-63.24; p=0.01], residents in long-term healthcare facilities (OR, 4.62; 95% CI, 2.08-10.29; p<0.001), and malignancy (OR, 2.24; 95% CI, 1.10-5.40; p=0.02). Conclusion: For adults with bacteremia visiting the ED, GNNF is associated with a higher mortality rate and more inappropriate empirical antibiotic therapy in the ED. To allow early administration of empirical antibiotics, several clinical predictors of GNNF infections were identified.

Original languageEnglish
Pages (from-to)92-100
Number of pages9
JournalJournal of Microbiology, Immunology and Infection
Volume48
Issue number1
DOIs
Publication statusPublished - 2015 Feb 1

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Bacteremia
Hospital Emergency Service
Odds Ratio
Confidence Intervals
Anti-Bacterial Agents
Mortality
Kaplan-Meier Estimate
Klebsiella pneumoniae
Anti-Infective Agents
Infection
Multivariate Analysis
Demography
Escherichia coli
Delivery of Health Care
Therapeutics
Neoplasms

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{254d7f55e7c045808fd686f627b69c96,
title = "Clinical impact of Gram-negative nonfermenters on adults with community-onset bacteremia in the emergency department",
abstract = "Background: To determine clinical predictors and impact of Gram-negative nonfermenters (GNNFs) infections among adults with community-onset bacteremia in the emergency department (ED). Methods: Adults with bacteremia visiting the ED from January 2007 to June 2008 were identified retrospectively. Demographic characteristics, underlying illnesses, clinical conditions, bacteremic pathogens, antimicrobial agents, and outcome, were retrieved from chart records. Results: After the exclusion of 261 patients with contamination of blood cultures and 24 patients referred from other hospitals, 518 adults with community-onset bacteremia were eligible; their mean age was 65.1 years, with slight predominance of female (262 patients, 50.6{\%}). Of a total of 565 bacteremic isolates, Escherichia coli (228 isolates, 40.4{\%}) and Klebsiella pneumoniae (100, 17.7{\%}) were the major microorganisms. GNNFs caused bacteremia in 31 (6.0{\%}) patients. A higher proportion of inappropriate antibiotic therapy in the ED (87.1{\%} vs. 26.5{\%}, p<0.001) and higher 28-day crude mortality rate (19.4{\%} vs. 8.4{\%}, p=0.05) were observed in bacteremic patients caused by GNNFs than those not caused by GNNFs. In further analysis of Kaplan-Meier survival curve, patients with GNNF bacteremia had a worse outcome than those due to other pathogens ( p=0.04). Multivariate analysis revealed that the independent predictors related to GNNF bacteremia included surgery during previous 4 weeks prior to ED arrival [odds ratio (OR), 10.79; 95{\%} confidence interval (CI), 1.84-63.24; p=0.01], residents in long-term healthcare facilities (OR, 4.62; 95{\%} CI, 2.08-10.29; p<0.001), and malignancy (OR, 2.24; 95{\%} CI, 1.10-5.40; p=0.02). Conclusion: For adults with bacteremia visiting the ED, GNNF is associated with a higher mortality rate and more inappropriate empirical antibiotic therapy in the ED. To allow early administration of empirical antibiotics, several clinical predictors of GNNF infections were identified.",
author = "Chiu, {Chun Wei} and Ming-Chi Li and Wen-Chien Ko and Chia-Wen Li and Po-Lin Chen and Chia-Ming Chang and Nan-Yao Lee and Lee, {Ching Chi}",
year = "2015",
month = "2",
day = "1",
doi = "10.1016/j.jmii.2013.08.004",
language = "English",
volume = "48",
pages = "92--100",
journal = "Journal of Microbiology, Immunology and Infection",
issn = "1684-1182",
publisher = "Elsevier Taiwan LLC",
number = "1",

}

TY - JOUR

T1 - Clinical impact of Gram-negative nonfermenters on adults with community-onset bacteremia in the emergency department

AU - Chiu, Chun Wei

AU - Li, Ming-Chi

AU - Ko, Wen-Chien

AU - Li, Chia-Wen

AU - Chen, Po-Lin

AU - Chang, Chia-Ming

AU - Lee, Nan-Yao

AU - Lee, Ching Chi

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background: To determine clinical predictors and impact of Gram-negative nonfermenters (GNNFs) infections among adults with community-onset bacteremia in the emergency department (ED). Methods: Adults with bacteremia visiting the ED from January 2007 to June 2008 were identified retrospectively. Demographic characteristics, underlying illnesses, clinical conditions, bacteremic pathogens, antimicrobial agents, and outcome, were retrieved from chart records. Results: After the exclusion of 261 patients with contamination of blood cultures and 24 patients referred from other hospitals, 518 adults with community-onset bacteremia were eligible; their mean age was 65.1 years, with slight predominance of female (262 patients, 50.6%). Of a total of 565 bacteremic isolates, Escherichia coli (228 isolates, 40.4%) and Klebsiella pneumoniae (100, 17.7%) were the major microorganisms. GNNFs caused bacteremia in 31 (6.0%) patients. A higher proportion of inappropriate antibiotic therapy in the ED (87.1% vs. 26.5%, p<0.001) and higher 28-day crude mortality rate (19.4% vs. 8.4%, p=0.05) were observed in bacteremic patients caused by GNNFs than those not caused by GNNFs. In further analysis of Kaplan-Meier survival curve, patients with GNNF bacteremia had a worse outcome than those due to other pathogens ( p=0.04). Multivariate analysis revealed that the independent predictors related to GNNF bacteremia included surgery during previous 4 weeks prior to ED arrival [odds ratio (OR), 10.79; 95% confidence interval (CI), 1.84-63.24; p=0.01], residents in long-term healthcare facilities (OR, 4.62; 95% CI, 2.08-10.29; p<0.001), and malignancy (OR, 2.24; 95% CI, 1.10-5.40; p=0.02). Conclusion: For adults with bacteremia visiting the ED, GNNF is associated with a higher mortality rate and more inappropriate empirical antibiotic therapy in the ED. To allow early administration of empirical antibiotics, several clinical predictors of GNNF infections were identified.

AB - Background: To determine clinical predictors and impact of Gram-negative nonfermenters (GNNFs) infections among adults with community-onset bacteremia in the emergency department (ED). Methods: Adults with bacteremia visiting the ED from January 2007 to June 2008 were identified retrospectively. Demographic characteristics, underlying illnesses, clinical conditions, bacteremic pathogens, antimicrobial agents, and outcome, were retrieved from chart records. Results: After the exclusion of 261 patients with contamination of blood cultures and 24 patients referred from other hospitals, 518 adults with community-onset bacteremia were eligible; their mean age was 65.1 years, with slight predominance of female (262 patients, 50.6%). Of a total of 565 bacteremic isolates, Escherichia coli (228 isolates, 40.4%) and Klebsiella pneumoniae (100, 17.7%) were the major microorganisms. GNNFs caused bacteremia in 31 (6.0%) patients. A higher proportion of inappropriate antibiotic therapy in the ED (87.1% vs. 26.5%, p<0.001) and higher 28-day crude mortality rate (19.4% vs. 8.4%, p=0.05) were observed in bacteremic patients caused by GNNFs than those not caused by GNNFs. In further analysis of Kaplan-Meier survival curve, patients with GNNF bacteremia had a worse outcome than those due to other pathogens ( p=0.04). Multivariate analysis revealed that the independent predictors related to GNNF bacteremia included surgery during previous 4 weeks prior to ED arrival [odds ratio (OR), 10.79; 95% confidence interval (CI), 1.84-63.24; p=0.01], residents in long-term healthcare facilities (OR, 4.62; 95% CI, 2.08-10.29; p<0.001), and malignancy (OR, 2.24; 95% CI, 1.10-5.40; p=0.02). Conclusion: For adults with bacteremia visiting the ED, GNNF is associated with a higher mortality rate and more inappropriate empirical antibiotic therapy in the ED. To allow early administration of empirical antibiotics, several clinical predictors of GNNF infections were identified.

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U2 - 10.1016/j.jmii.2013.08.004

DO - 10.1016/j.jmii.2013.08.004

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VL - 48

SP - 92

EP - 100

JO - Journal of Microbiology, Immunology and Infection

JF - Journal of Microbiology, Immunology and Infection

SN - 1684-1182

IS - 1

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