Clinical factors predictive of Gram-negative bloodstream infection at the Emergency Department

Pariwat Phungoen; Korakot Apiratwarakul; Nunchalit Lerdprawat; Kamonwon Ienghong; Sumana Sumritrin; Watchara Boonsawat; Kittisak Sawanyawisuth

doi:10.18683/germs.2022.1325

Clinical factors predictive of Gram-negative bloodstream infection at the Emergency Department

Germs. 2022 Jun 30;12(2):231-237. doi: 10.18683/germs.2022.1325. eCollection 2022 Jun.

Authors

Pariwat Phungoen¹, Korakot Apiratwarakul¹, Nunchalit Lerdprawat¹, Kamonwon Ienghong¹, Sumana Sumritrin², Watchara Boonsawat³, Kittisak Sawanyawisuth³

Affiliations

¹ MD, Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
² MSc, Accidental and Emergency Unit, Division of Nursing, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
³ MD, PhD, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.

Abstract

Introduction: Bloodstream infection is a common condition at the Emergency Department (ED). Appropriate antibiotic therapy is also crucial for patients with bloodstream infection particularly at the ED. This study therefore aimed to find clinical factors predictive of types of bacterial pathogens in bloodstream infection patients presenting at the ED focused on Gram-negative bacterial infections.

Methods: This was a retrospective study. The inclusion criteria were adult patients who were suspected for bloodstream infection defined by blood culture collection presenting at the ED and intravenous antibiotics were initiated during the ED visits. The study period was between January 1^st, 2016 and December 31^st, 2018. Clinical data of the eligible patients were retrieved from the ED database. Factors associated with Gram-negative infection were calculated by logistic regression analysis.

Results: There were 727 patients at the ED who had positive blood culture for bacteria. Of those, 504 patients (69.33%) had positive blood culture for Gram-negative bacteria. There were three independent factors for Gram-negative infection including sex, solid organ malignancy, and body temperature. The highest adjusted odds ratio (95% confidence interval) was 2.004 (1.330, 3.020) for solid organ malignancy.

Conclusions: Gram-negative bacterial infection was more prominent than Gram-positive bacterial infection in patients presenting at the ED (69.33%). Solid organ malignancy, being female, and a high body temperature were independent factors of Gram-negative bacterial infection.

Keywords: Sepsis; fever; risk factor; sex.

GERMS.