Adult Patients With Occult Bacteremia Discharged from Emergency Department

從急診出院的成人潛在性菌血症

吳銘斌(Ming-Pin Wu) ； 林芸合(Yun-Ho Lin) ； 林幸儀(Shing-Yi Lin)

《台灣急診專科醫師期刊》 6卷1期 (2014/03) Pp. 1-6

摘要

目的:探討從急診出院的成人菌血症之發生率、病人特性及預後。方法:以教學醫院為基礎之回顧性分析，時間自2012年1月1日至2012年12月31日，對象為急診求診之成人菌血症患者。結果:排除污染的檢體後共有872個血液培養呈陽性反應。其中33個病人(34個檢體)血液培養呈陽性反應直接從急診出院。粗發生率為3.9%。男性14人(42.4%)，女性19人(57.6%)。平均年齡57.3歲(24至88歲)，其中13人(39.4%)年齡大於65歲。最常見的臨床表現為發燒(84.9%)。最常見的診斷為泌尿道感染urinary tract infection (36.4%)，最常見的致病菌為大腸桿菌(38.2%)。33人中只有16(48.5%)人返診，其臨床症狀穩定並未出現敗血症的現象。結論:潛在性菌血症對急診而言是一個病人安全的問題。在我們的研究中，其發生率並不高。大腸桿菌所造成的泌尿道感染是最主要的診斷。實驗室的檢查並未提供決定性的診斷。返診病人大多預後良好。

關鍵字

潛在性菌血症 ； 血液培養 ； 急診室

並列摘要

Objective: to determine the incidence, characters, and the outcome of adult patients with occult bacteremia discharged from emergency department (ED). Methods: a retrospective analysis study was conducted at the ED of a referral teaching hospital between 1 January，2012 and 31 December, 2012. Adult patients discharged from ED reported with positive blood cultures were studies. Results: 872 blood cultures revealed positive results. 33 patients with 34 positive blood cultures were discharged from emergency department directly. The crude incidence rate was 3.9%. There were 14 male (42.4 %) and 19 female (57.6%). The average age was 57.3 years (range, 24-88 years), and 13 patients (39 .4 %) were aged above 65 years. The clinical features presented most as fever in 28 patients (84.9 %). The most common diagnosis was urinary tract infection in 12 patients (36.4%). The most common isolated pathogen was Escherichia coli (n=12, 35.3%). 16 of 33 patients (48.5%) come back for second survey. Clinical condition in these patients was stable, and no one progressed to sepsis. Conclusion: occult bacteremia is a patient safety problem in ED. In our study the incidence rate is low (3.9 %). The most common diagnosis and pathogen are urinary tract infection and Escherichia coli separately The laboratory tests did not offer decisive diagnosis. Outcome of return visit patients are doing well.

並列關鍵字

occult bacteremia ； blood culture ； emergency department