Occult bloodstream infections in adults: a “benign” entity
Abstract Background Patients with septic episodes whose blood cultures turn positive after being sent home from emergency departments (EDs) are recognized as having occult bloodstream infections (BSI). The incidence, etiology, clinical circumstances, and outcome of occult BSI in children are well kn...
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| Veröffentlicht in: | The American journal of emergency medicine 2014-09, Vol.32 (9), p.966-971 |
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| creator | González-Del Vecchio, Marcela, MD Bunsow, Eleonora, MD Sánchez-Carrillo, Carlos, PharmD Garcia Leoni, Eugenia, MD, PhD Rodríguez-Créixems, Marta, MD, PhD Bouza, Emilio, MD, PhD |
| description | Abstract Background Patients with septic episodes whose blood cultures turn positive after being sent home from emergency departments (EDs) are recognized as having occult bloodstream infections (BSI). The incidence, etiology, clinical circumstances, and outcome of occult BSI in children are well known, but, to our knowledge, data in adult patients are scarce. We analyzed the episodes of occult BSI in adult patients at our institution. Methods This is a retrospective cohort study (September 2010 to September 2012), in adult patients discharged from the ED in whom blood cultures turned positive. Patients were evaluated according to a preestablished protocol. Results We recorded 4025 cases of significant BSI in the ED and 113 patients with adult occult BSI. In other words, the incidence of occult BSI in the ED was 2.8 per 100 episodes. The predominant microorganisms were gram-negative bacteria (57%); Escherichia coli was the most common (41%), followed by gram-positive bacteria (29%), anaerobes (6.9%), polymicrobial (6.1%), and yeasts (0.8%). The most frequent suspected origin was urinary tract infection (53%), and most infections were community acquired (63.7%). Of the 105 patients that we were able to trace, 54 (42.5%) were asymptomatic and were receiving adequate antibiotic treatment at the time of the call, and 65 (51.2%) had persistent fever or were not receiving adequate antibiotic treatment. Conclusions Occult BSI is relatively common in patients in the adult ED. Despite the need for readmission of a fairly high proportion of patients, occult BSI behaves as a relatively benign entity. |
| doi_str_mv | 10.1016/j.ajem.2014.05.007 |
| format | Article |
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The incidence, etiology, clinical circumstances, and outcome of occult BSI in children are well known, but, to our knowledge, data in adult patients are scarce. We analyzed the episodes of occult BSI in adult patients at our institution. Methods This is a retrospective cohort study (September 2010 to September 2012), in adult patients discharged from the ED in whom blood cultures turned positive. Patients were evaluated according to a preestablished protocol. Results We recorded 4025 cases of significant BSI in the ED and 113 patients with adult occult BSI. In other words, the incidence of occult BSI in the ED was 2.8 per 100 episodes. The predominant microorganisms were gram-negative bacteria (57%); Escherichia coli was the most common (41%), followed by gram-positive bacteria (29%), anaerobes (6.9%), polymicrobial (6.1%), and yeasts (0.8%). The most frequent suspected origin was urinary tract infection (53%), and most infections were community acquired (63.7%). Of the 105 patients that we were able to trace, 54 (42.5%) were asymptomatic and were receiving adequate antibiotic treatment at the time of the call, and 65 (51.2%) had persistent fever or were not receiving adequate antibiotic treatment. Conclusions Occult BSI is relatively common in patients in the adult ED. Despite the need for readmission of a fairly high proportion of patients, occult BSI behaves as a relatively benign entity.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2014.05.007</identifier><identifier>PMID: 24997579</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdomen ; Adult ; Aged ; Antibiotics ; Bacteremia - diagnosis ; Bacteremia - epidemiology ; Bacteremia - microbiology ; Bacteria ; Blood ; Committees ; Community-Acquired Infections - diagnosis ; Community-Acquired Infections - epidemiology ; Community-Acquired Infections - microbiology ; Drug therapy ; Emergency ; Emergency medical care ; Emergency Service, Hospital - statistics & numerical data ; Female ; Gram-Negative Bacterial Infections - diagnosis ; Gram-Negative Bacterial Infections - epidemiology ; Gram-Negative Bacterial Infections - microbiology ; Gram-positive bacteria ; Gram-Positive Bacterial Infections - diagnosis ; Gram-Positive Bacterial Infections - epidemiology ; Gram-Positive Bacterial Infections - microbiology ; HIV ; Hospitalization ; Hospitals, Teaching - statistics & numerical data ; Human immunodeficiency virus ; Humans ; Infections ; Internal medicine ; Laboratories ; Male ; Medical imaging ; Medicine ; Microorganisms ; Middle Aged ; Mortality ; Occult sciences ; Palliative care ; Patient Discharge - statistics & numerical data ; Population ; Retrospective Studies ; Studies ; Teaching hospitals ; Urinary tract diseases ; Urogenital system ; Yeasts</subject><ispartof>The American journal of emergency medicine, 2014-09, Vol.32 (9), p.966-971</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c509t-42f5b5bea1a8190474088993cf310f1a27f8f35937f0af492ed7a419fc4662c63</citedby><cites>FETCH-LOGICAL-c509t-42f5b5bea1a8190474088993cf310f1a27f8f35937f0af492ed7a419fc4662c63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S073567571400326X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24997579$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>González-Del Vecchio, Marcela, MD</creatorcontrib><creatorcontrib>Bunsow, Eleonora, MD</creatorcontrib><creatorcontrib>Sánchez-Carrillo, Carlos, PharmD</creatorcontrib><creatorcontrib>Garcia Leoni, Eugenia, MD, PhD</creatorcontrib><creatorcontrib>Rodríguez-Créixems, Marta, MD, PhD</creatorcontrib><creatorcontrib>Bouza, Emilio, MD, PhD</creatorcontrib><title>Occult bloodstream infections in adults: a “benign” entity</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract Background Patients with septic episodes whose blood cultures turn positive after being sent home from emergency departments (EDs) are recognized as having occult bloodstream infections (BSI). The incidence, etiology, clinical circumstances, and outcome of occult BSI in children are well known, but, to our knowledge, data in adult patients are scarce. We analyzed the episodes of occult BSI in adult patients at our institution. Methods This is a retrospective cohort study (September 2010 to September 2012), in adult patients discharged from the ED in whom blood cultures turned positive. Patients were evaluated according to a preestablished protocol. Results We recorded 4025 cases of significant BSI in the ED and 113 patients with adult occult BSI. In other words, the incidence of occult BSI in the ED was 2.8 per 100 episodes. The predominant microorganisms were gram-negative bacteria (57%); Escherichia coli was the most common (41%), followed by gram-positive bacteria (29%), anaerobes (6.9%), polymicrobial (6.1%), and yeasts (0.8%). The most frequent suspected origin was urinary tract infection (53%), and most infections were community acquired (63.7%). Of the 105 patients that we were able to trace, 54 (42.5%) were asymptomatic and were receiving adequate antibiotic treatment at the time of the call, and 65 (51.2%) had persistent fever or were not receiving adequate antibiotic treatment. Conclusions Occult BSI is relatively common in patients in the adult ED. Despite the need for readmission of a fairly high proportion of patients, occult BSI behaves as a relatively benign entity.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Aged</subject><subject>Antibiotics</subject><subject>Bacteremia - diagnosis</subject><subject>Bacteremia - epidemiology</subject><subject>Bacteremia - microbiology</subject><subject>Bacteria</subject><subject>Blood</subject><subject>Committees</subject><subject>Community-Acquired Infections - diagnosis</subject><subject>Community-Acquired Infections - epidemiology</subject><subject>Community-Acquired Infections - microbiology</subject><subject>Drug therapy</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Gram-Negative Bacterial Infections - diagnosis</subject><subject>Gram-Negative Bacterial Infections - epidemiology</subject><subject>Gram-Negative Bacterial Infections - microbiology</subject><subject>Gram-positive bacteria</subject><subject>Gram-Positive Bacterial Infections - diagnosis</subject><subject>Gram-Positive Bacterial Infections - epidemiology</subject><subject>Gram-Positive Bacterial Infections - microbiology</subject><subject>HIV</subject><subject>Hospitalization</subject><subject>Hospitals, Teaching - statistics & numerical data</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infections</subject><subject>Internal medicine</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Microorganisms</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Occult sciences</subject><subject>Palliative care</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Population</subject><subject>Retrospective Studies</subject><subject>Studies</subject><subject>Teaching hospitals</subject><subject>Urinary tract diseases</subject><subject>Urogenital system</subject><subject>Yeasts</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc-K1TAUh4Mozp3RF3AhBTduWnPyp2lEBmRwVBiYhQruQpqeSGqbjk07cHfzIPpy8ySm3FFhFm6SkHznR853CHkGtAIK9au-sj2OFaMgKiorStUDsgPJWdmAgodkRxWXZa2kOiLHKfWUAggpHpMjJrTO13pHTi-dW4elaIdp6tIyox2LED26JUwx5WNhu_yeXhe2uL352WIM3-Ltza8C4xKW_RPyyNsh4dO7_YR8OX_3-exDeXH5_uPZ24vSSaqXUjAvW9miBduApkIJ2jRac-c5UA-WKd94LjVXnlovNMNOWQHaO1HXzNX8hLw85F7N048V02LGkBwOg404rcmArIFyVqsNfXEP7ad1jvl3BmrgTV7ERrED5eYppRm9uZrDaOe9AWo2u6Y3m12z2TVUmmw3Fz2_i17bEbu_JX90ZuDNAcDs4jrgbJILGB12Yc5KTTeF_-ef3it3Q4jB2eE77jH968MkZqj5tM13Gy8IujX_lf8GY-Gfvg</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>González-Del Vecchio, Marcela, MD</creator><creator>Bunsow, Eleonora, MD</creator><creator>Sánchez-Carrillo, Carlos, PharmD</creator><creator>Garcia Leoni, Eugenia, MD, PhD</creator><creator>Rodríguez-Créixems, Marta, MD, PhD</creator><creator>Bouza, Emilio, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20140901</creationdate><title>Occult bloodstream infections in adults: a “benign” entity</title><author>González-Del Vecchio, Marcela, MD ; Bunsow, Eleonora, MD ; Sánchez-Carrillo, Carlos, PharmD ; Garcia Leoni, Eugenia, MD, PhD ; Rodríguez-Créixems, Marta, MD, PhD ; Bouza, Emilio, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c509t-42f5b5bea1a8190474088993cf310f1a27f8f35937f0af492ed7a419fc4662c63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Abdomen</topic><topic>Adult</topic><topic>Aged</topic><topic>Antibiotics</topic><topic>Bacteremia - diagnosis</topic><topic>Bacteremia - epidemiology</topic><topic>Bacteremia - microbiology</topic><topic>Bacteria</topic><topic>Blood</topic><topic>Committees</topic><topic>Community-Acquired Infections - diagnosis</topic><topic>Community-Acquired Infections - epidemiology</topic><topic>Community-Acquired Infections - microbiology</topic><topic>Drug therapy</topic><topic>Emergency</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Gram-Negative Bacterial Infections - diagnosis</topic><topic>Gram-Negative Bacterial Infections - epidemiology</topic><topic>Gram-Negative Bacterial Infections - microbiology</topic><topic>Gram-positive bacteria</topic><topic>Gram-Positive Bacterial Infections - diagnosis</topic><topic>Gram-Positive Bacterial Infections - epidemiology</topic><topic>Gram-Positive Bacterial Infections - microbiology</topic><topic>HIV</topic><topic>Hospitalization</topic><topic>Hospitals, Teaching - statistics & numerical data</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Infections</topic><topic>Internal medicine</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Microorganisms</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Occult sciences</topic><topic>Palliative care</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Population</topic><topic>Retrospective Studies</topic><topic>Studies</topic><topic>Teaching hospitals</topic><topic>Urinary tract diseases</topic><topic>Urogenital system</topic><topic>Yeasts</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>González-Del Vecchio, Marcela, MD</creatorcontrib><creatorcontrib>Bunsow, Eleonora, MD</creatorcontrib><creatorcontrib>Sánchez-Carrillo, Carlos, PharmD</creatorcontrib><creatorcontrib>Garcia Leoni, Eugenia, MD, PhD</creatorcontrib><creatorcontrib>Rodríguez-Créixems, Marta, MD, PhD</creatorcontrib><creatorcontrib>Bouza, Emilio, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>González-Del Vecchio, Marcela, MD</au><au>Bunsow, Eleonora, MD</au><au>Sánchez-Carrillo, Carlos, PharmD</au><au>Garcia Leoni, Eugenia, MD, PhD</au><au>Rodríguez-Créixems, Marta, MD, PhD</au><au>Bouza, Emilio, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Occult bloodstream infections in adults: a “benign” entity</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>32</volume><issue>9</issue><spage>966</spage><epage>971</epage><pages>966-971</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>Abstract Background Patients with septic episodes whose blood cultures turn positive after being sent home from emergency departments (EDs) are recognized as having occult bloodstream infections (BSI). The incidence, etiology, clinical circumstances, and outcome of occult BSI in children are well known, but, to our knowledge, data in adult patients are scarce. We analyzed the episodes of occult BSI in adult patients at our institution. Methods This is a retrospective cohort study (September 2010 to September 2012), in adult patients discharged from the ED in whom blood cultures turned positive. Patients were evaluated according to a preestablished protocol. Results We recorded 4025 cases of significant BSI in the ED and 113 patients with adult occult BSI. In other words, the incidence of occult BSI in the ED was 2.8 per 100 episodes. The predominant microorganisms were gram-negative bacteria (57%); Escherichia coli was the most common (41%), followed by gram-positive bacteria (29%), anaerobes (6.9%), polymicrobial (6.1%), and yeasts (0.8%). The most frequent suspected origin was urinary tract infection (53%), and most infections were community acquired (63.7%). Of the 105 patients that we were able to trace, 54 (42.5%) were asymptomatic and were receiving adequate antibiotic treatment at the time of the call, and 65 (51.2%) had persistent fever or were not receiving adequate antibiotic treatment. Conclusions Occult BSI is relatively common in patients in the adult ED. Despite the need for readmission of a fairly high proportion of patients, occult BSI behaves as a relatively benign entity.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24997579</pmid><doi>10.1016/j.ajem.2014.05.007</doi><tpages>6</tpages></addata></record> |
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| subjects | Abdomen Adult Aged Antibiotics Bacteremia - diagnosis Bacteremia - epidemiology Bacteremia - microbiology Bacteria Blood Committees Community-Acquired Infections - diagnosis Community-Acquired Infections - epidemiology Community-Acquired Infections - microbiology Drug therapy Emergency Emergency medical care Emergency Service, Hospital - statistics & numerical data Female Gram-Negative Bacterial Infections - diagnosis Gram-Negative Bacterial Infections - epidemiology Gram-Negative Bacterial Infections - microbiology Gram-positive bacteria Gram-Positive Bacterial Infections - diagnosis Gram-Positive Bacterial Infections - epidemiology Gram-Positive Bacterial Infections - microbiology HIV Hospitalization Hospitals, Teaching - statistics & numerical data Human immunodeficiency virus Humans Infections Internal medicine Laboratories Male Medical imaging Medicine Microorganisms Middle Aged Mortality Occult sciences Palliative care Patient Discharge - statistics & numerical data Population Retrospective Studies Studies Teaching hospitals Urinary tract diseases Urogenital system Yeasts |
| title | Occult bloodstream infections in adults: a “benign” entity |
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