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Risk factors for hospital admission in patients with occult Escherichia coli bacteraemia discharged from the emergency department

Abstract number: P1828

Peralta G., Rodriguez-Lera M.J., Ceballos B., Alonso S., Roiz M.P., De Benito I., Teira R., Sanchez M.B., Garrido J.C., Mateos F., Padron E.

Background:Escherichia coli is the most frequent Gram-negative organism causing bacteraemia. Few studies dealing with occult bacteraemia in adult patients have been published, and none of them addresses specifically E. coli bacteraemia.

Methods: In our hospital patients with occult bacteraemia discharged from the emergency department (ED) are followed with a specific protocol. We reviewed all patients with occult E. coli bacteraemia discharged from the ED in a ten year period. A total of more than 20 variables including epidemiological and clinical aspects of E. coli bacteraemia cases were evaluated. Chi square test or the Fisher test were used for categorical variables and t-test for continuous variables. Logistic regression model was used to identify factors independently associated with hospital admission after detecting bacteraemia.

Results: From January 1997 to December 2006 we identified 261 patients with occult bacteraemia due to E. coli discharged from the ED. Of them, 174 (66.7%) required hospital admission. The origin of the bacteraemia was a urinary infection in 207 (79.9%), unknown in 32 (12.4%), biliary in 10 (3.8%) and other origins in 12 (4.6%). A higher proportion of patients who did not require hospitalisation were younger than 65 years (51.1 vs 35.6%, p = 0.03), received adequate antibiotic empirical treatment (84.4% vs 71.3%, p = 0.01) or at least one dose of parenteral antibiotic in the ED (77.6% vs 58.6%, p = 0.001). Among 160 patients who had received adequate antibiotic empirical treatment we detected significant differences in the rates of hospital admission depending on the reception of at least one dose of parenteral antibiotic (62.9% vs 82.9%, p = 0.002). In a regression logistic analysis, age older than 65 years (ORa, 95% CI: 1.74, 1.01–2.99, p = 0.05), and receiving at least one dose of parenteral antibiotic in the ED (ORa, 95% CI: 0.41, 0.23–0.71, p = 0.002) were associated with hospital admission.

Conclusion: Our data suggest that in patients with suspected bacteraemia due to E. coli discharged from an ED, initial treatment with at least one dose of adequate parenteral antibiotic could avoid hospital admissions.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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