부산대학교 도서관

Objective: The aim of this study was to determine the clinical features, bacteriology, and outcomes of patients with bacteremia in the emergency department. Methods: We performed a retrospective analysis of adult bacteremia patients admitted to the emergency department at Li-Shin Hospital in northern Taiwan from January 2005 through December 2005. Demographic data, clinical features, empiric antibiotic prescriptions and outcomes were collected for analysis. Results: During the study period, 54565 adult patients visited the emergency department. The incidence of bacteremia was approximately 0.5%. A total of 286 microorganism strains were isolated from 280 patients. There were 120 men and 160 women. The mean age was 64.6±18 years (range, 17-102 years). The clinical manifestations included sepsis in 133 patients (48.2%), severe sepsis in 72 patients (25.7%), and septic shock in 15 patients (5.4%). The most common diagnosis was urinary tract infection (36.4%), followed by fever of undetermined source (31.4%), and respiratory tract infection (19.3%). Gram-negative microorganisms were isolated in 209 isolates (73%). The most commonly isolated microorganism was Escherichia coli (42.6%), followed by Staphylococcus species (13.7%), Klebsiella pneumoniae (13%), Streptococcus species (7.7%), and Salmonella species (5.6%). One hundred and forty-one patients (50.4%) received empirically inadequate antibiotic treatment. A total of 212 patients (75.8%) were admitted, among whom, 19 patients (9%) died. The significant independent risk factors for death of the admitted patients were advanced age (p=0.01), underlying heart disease (p=0.02), bandemia (p=0.01), anemia (p=0.05), inadequate antibiotic treatment (p＜0.01), and complicated acute respiratory failure (p＜0.001). Conclusion: The results of this study emphasize the clinical characteristics of patients with bacteremia and highlights the independent prognostic factors of admitted patients in the emergency department. Elevation of adequate of antibiotics use is an important issue. In addition, in a patient suggested of having bacteremia with high mortality risk factors, emergency department physicians should pay particular attention and utilize more aggressive treatment strategies in an effort to lower the mortality rate.