[Retrospective study of bacteremia diagnosed in an emergency department: frequency, susceptibility of microorganisms, and impact on therapeutic management].

OBJECTIVE

The authors had for aim to determine the prevalence of bacteremia diagnosed in an emergency department (ED), the susceptibility of microorganisms to antibiotics, and the impact on therapeutic management.

DESIGN

A retrospective analysis was made on patient features, microbiological ecology, susceptibility to antibiotics, and modalities of antimicrobial therapy in the Georges Pompidou European hospital ED of Hôpital, between 1 November 2001 and 30 June 2002.

RESULTS

One thousand four hundred and thirty two blood cultures were obtained from 1069 patients. The rate of positive cultures was 12%, but only 8.7% (n = 125) were proved as true bacteremia. The most frequently identified organisms were: Enterobacteriaceae (n = 63, 39.4%) with a predominance of Escherichia coli (n = 48, 30%), and Streptococcus pneumoniae (n = 16, 10%). Forty two cases of pyelonephritis and 34 of prostatitis both due to E. coli were diagnosed. 76.5% of these were resistant to amoxicillin, 64.7% to amoxicillin-clavulanic acid, 11.8% to ciprofloxacin, and 44% to cotrimoxazole. No resistance to third generation cephalosporin was detected in E. coli isolates. Fourteen S. pneumoniae pneumonia cases were diagnosed. 57.1% of isolates presented with a decreased susceptibility to penicillin (CMI > 0.1 mg/l). Susceptibility to amoxicillin and cefotaxim was 85.7% and 92.9% respectively. Blood culture was the only exam available for bacterial diagnosis in 51.5% of true bacteremia. 1.6% of blood cultures from ED samples had an impact on therapeutic management.

CONCLUSIONS

Blood culture is a relevant exam for the diagnosis of infection in patients admitted to the ED.