[Source: PLoS One, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study
Kathrin Rothe , Christoph D. Spinner, Armin Ott, Christiane Querbach, Michael Dommasch, Cassandra Aldrich, Friedemann Gebhardt, Jochen Schneider, Roland M. Schmid, Dirk H. Busch, Juri Katchanov
Published: September 12, 2019 / DOI: https://doi.org/10.1371/journal.pone.0222545
Bloodstream infections (BSI) are associated with high mortality. Therefore, reliable methods of detection are of paramount importance. Efficient strategies to improve diagnostic yield of bacteraemia within the emergency department (ED) are needed. We conducted a retrospective analysis of all ED encounters in a high-volume, city-centre university hospital within Germany during a five-year study period from October 2013 to September 2018. A time-series analysis was conducted for all ED encounters in which blood cultures (BCs) were collected. BC detection rates and diagnostic yield of community-onset bacteraemia were compared during the study period (which included 45 months prior to the start of a new diagnostic Antibiotic Stewardship (ABS) bundle and 15 months following its implementation). BCs were obtained from 5,191 out of 66,879 ED admissions (7.8%). Bacteraemia was detected in 1,013 encounters (19.5% of encounters where BCs were obtained). The overall yield of true bacteraemia (defined as yielding clinically relevant pathogens) was 14.4%. The new ABS-related diagnostic protocol resulted in an increased number of hospitalised patients with BCs collected in the ED (18% compared to 12.3%) and a significant increase in patients with two or more BC sets taken (59% compared to 25.4%), which resulted in an improved detection rate of true bacteraemia (2.5% versus 1.8% of hospital admissions) without any decrease in diagnostic yield. This simultaneous increase in BC rates without degradation of yield was a valuable finding that indicated success of this strategy. Thus, implementation of the new diagnostic ABS bundle within the ED, which included the presence of a skilled infectious disease (ID) team focused on obtaining BCs, appeared to be a valuable tool for the accurate and timely detection of community-onset bacteraemia.
Citation: Rothe K, Spinner CD, Ott A, Querbach C, Dommasch M, Aldrich C, et al. (2019) Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study. PLoS ONE 14(9): e0222545. https://doi.org/10.1371/journal.pone.0222545
Editor: Wisit Cheungpasitporn, University of Mississippi Medical Center, UNITED STATES
Received: June 24, 2019; Accepted: August 31, 2019; Published: September 12, 2019
Copyright: © 2019 Rothe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Keywords: Bacteremia; Antibiotics.