Different clinical presentation of community-onset bacteremia among neutropenic adults in the ED

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Abstract

Objectives To analyze the differences in clinical presentation and characteristics of community-onset bacteremia between neutropenic and nonneutropenic adults visiting the emergency department. Methods A case-control study with a ratio of 1:2 was conducted retrospectively over a 6-year period. Demographic characteristics, microorganisms, severity of illness, and clinical outcomes determined from medical records were analyzed. Results In total, 116 neutropenic adults (case patients) and 232 nonneutropenic adults (control patients) were examined. Significant differences in the source of bacteremia, susceptibility, and species of bacteremia-causing organisms between the case patients and control patients were observed by univariate analyses. Significantly more patients presenting with an initial syndrome of severe sepsis or septic shock at the emergency department, having high Pittsburgh bacteremia scores (a 4 points) or having severe comorbidities (McCabe classification), and high 28-day mortality rates were discovered in the case group, compared with the control group. Of note, Pseudomonas aeruginosa (32/137 [23.4%] vs 8/272 [2.9%], P <.001) was more often isolated from the case patients. In a further analysis using a multivariate regression to demonstrate the independent predictors of P aeruginosa infection, patients with neutropenia remained as an independent risk factors (odds ratio, 7.48; P <.001). Conclusions This study demonstrated obvious differences of community-onset bacteremia in severity, the distribution of microorganisms, and susceptibility between neutropenic and nonneutropenic patients. Antipseudomonas therapy was empirically suggested for neutropenic patients with community-onset bacteremia and reducing the need for a glycopeptide.

Original languageEnglish
Pages (from-to)907-912
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number7
DOIs
Publication statusPublished - 2015 Jul 1

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Bacteremia
Hospital Emergency Service
Glycopeptides
Septic Shock
Neutropenia
Pseudomonas aeruginosa
Medical Records
Case-Control Studies
Comorbidity
Sepsis
Odds Ratio
Demography
Control Groups
Mortality
Infection

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

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title = "Different clinical presentation of community-onset bacteremia among neutropenic adults in the ED",
abstract = "Objectives To analyze the differences in clinical presentation and characteristics of community-onset bacteremia between neutropenic and nonneutropenic adults visiting the emergency department. Methods A case-control study with a ratio of 1:2 was conducted retrospectively over a 6-year period. Demographic characteristics, microorganisms, severity of illness, and clinical outcomes determined from medical records were analyzed. Results In total, 116 neutropenic adults (case patients) and 232 nonneutropenic adults (control patients) were examined. Significant differences in the source of bacteremia, susceptibility, and species of bacteremia-causing organisms between the case patients and control patients were observed by univariate analyses. Significantly more patients presenting with an initial syndrome of severe sepsis or septic shock at the emergency department, having high Pittsburgh bacteremia scores (a 4 points) or having severe comorbidities (McCabe classification), and high 28-day mortality rates were discovered in the case group, compared with the control group. Of note, Pseudomonas aeruginosa (32/137 [23.4{\%}] vs 8/272 [2.9{\%}], P <.001) was more often isolated from the case patients. In a further analysis using a multivariate regression to demonstrate the independent predictors of P aeruginosa infection, patients with neutropenia remained as an independent risk factors (odds ratio, 7.48; P <.001). Conclusions This study demonstrated obvious differences of community-onset bacteremia in severity, the distribution of microorganisms, and susceptibility between neutropenic and nonneutropenic patients. Antipseudomonas therapy was empirically suggested for neutropenic patients with community-onset bacteremia and reducing the need for a glycopeptide.",
author = "Lee, {Ching Chi} and Chih-Chia Hsieh and Nan-Yao Lee and Tsung-Yu Chan and Ming-Yuan Hong and Chih-Hsien Chi and Wen-Chien Ko",
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doi = "10.1016/j.ajem.2015.03.058",
language = "English",
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T1 - Different clinical presentation of community-onset bacteremia among neutropenic adults in the ED

AU - Lee, Ching Chi

AU - Hsieh, Chih-Chia

AU - Lee, Nan-Yao

AU - Chan, Tsung-Yu

AU - Hong, Ming-Yuan

AU - Chi, Chih-Hsien

AU - Ko, Wen-Chien

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Objectives To analyze the differences in clinical presentation and characteristics of community-onset bacteremia between neutropenic and nonneutropenic adults visiting the emergency department. Methods A case-control study with a ratio of 1:2 was conducted retrospectively over a 6-year period. Demographic characteristics, microorganisms, severity of illness, and clinical outcomes determined from medical records were analyzed. Results In total, 116 neutropenic adults (case patients) and 232 nonneutropenic adults (control patients) were examined. Significant differences in the source of bacteremia, susceptibility, and species of bacteremia-causing organisms between the case patients and control patients were observed by univariate analyses. Significantly more patients presenting with an initial syndrome of severe sepsis or septic shock at the emergency department, having high Pittsburgh bacteremia scores (a 4 points) or having severe comorbidities (McCabe classification), and high 28-day mortality rates were discovered in the case group, compared with the control group. Of note, Pseudomonas aeruginosa (32/137 [23.4%] vs 8/272 [2.9%], P <.001) was more often isolated from the case patients. In a further analysis using a multivariate regression to demonstrate the independent predictors of P aeruginosa infection, patients with neutropenia remained as an independent risk factors (odds ratio, 7.48; P <.001). Conclusions This study demonstrated obvious differences of community-onset bacteremia in severity, the distribution of microorganisms, and susceptibility between neutropenic and nonneutropenic patients. Antipseudomonas therapy was empirically suggested for neutropenic patients with community-onset bacteremia and reducing the need for a glycopeptide.

AB - Objectives To analyze the differences in clinical presentation and characteristics of community-onset bacteremia between neutropenic and nonneutropenic adults visiting the emergency department. Methods A case-control study with a ratio of 1:2 was conducted retrospectively over a 6-year period. Demographic characteristics, microorganisms, severity of illness, and clinical outcomes determined from medical records were analyzed. Results In total, 116 neutropenic adults (case patients) and 232 nonneutropenic adults (control patients) were examined. Significant differences in the source of bacteremia, susceptibility, and species of bacteremia-causing organisms between the case patients and control patients were observed by univariate analyses. Significantly more patients presenting with an initial syndrome of severe sepsis or septic shock at the emergency department, having high Pittsburgh bacteremia scores (a 4 points) or having severe comorbidities (McCabe classification), and high 28-day mortality rates were discovered in the case group, compared with the control group. Of note, Pseudomonas aeruginosa (32/137 [23.4%] vs 8/272 [2.9%], P <.001) was more often isolated from the case patients. In a further analysis using a multivariate regression to demonstrate the independent predictors of P aeruginosa infection, patients with neutropenia remained as an independent risk factors (odds ratio, 7.48; P <.001). Conclusions This study demonstrated obvious differences of community-onset bacteremia in severity, the distribution of microorganisms, and susceptibility between neutropenic and nonneutropenic patients. Antipseudomonas therapy was empirically suggested for neutropenic patients with community-onset bacteremia and reducing the need for a glycopeptide.

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JF - American Journal of Emergency Medicine

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