Patients with bacteraemia discharged from the department of emergency medicine: distribution of organisms and associated characteristics

Introduction: Although blood cultures are commonly used to investigate febrile patients presenting to an emergency department, treatment decisions usually have to be made before the results are available.Methods: We performed a retrospective analysis of consecutive patients presenting with community-acquired bacteraemia at the emergency department of Nambour Hospital, Queensland, Australia between 2000 and 2008. We determined their clinical characteristics, the distribution of organisms and also assessed patient characteristics associated with discharge from the emergency department.Results: A total of 885 patients with 915 presentations of community-acquired bacteraemia were included. While having bacteraemia, 33 patients (3.6%) were discharged from the emergency department. Age, mode of presentation, altered mental state, presence of immunocompromise, presence of respiratory distress, C reactive protein, Charlson score, age score and estimated 10 years survival were significant factors discriminating the admitted from discharged patients. The most commonly found organism in blood cultures of discharged patients was Staphylococcus aureus (27.3%), whereas in admitted patients it was E. coli (27.7%). Methicillin-resistant Staphylococcus aureus accounted for 1.7% of cases of community-acquired bacteraemia.Conclusions: Emergency physicians only rarely discharge patients with community-acquired bacteraemia using current assessment tools and decisionmaking rules. However, they tend to discharge younger self-presenting patients with good baseline function.