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Title: No Fever, No Worries? A Retrospective Audit of Bacteraemic Patients in the Emergency Department.
Authors: Chiodo-Reidy, Jessica;Loftus, Michael J;Holmes, Natasha E
Affiliation: Infectious Diseases, Alfred Health
Austin Health Clinical School, The University of Melbourne, Heidelberg, Victoria, Australia
The University of Melbourne, Heidelberg, Victoria, Australia
Mercy Hospital for Women, Heidelberg, Victoria, Australia
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 15-Jun-2020
EDate: 2020-06-15
Citation: Internal Medicine Journal 2020; online first: 15 June
Abstract: Early identification and treatment of serious infections improves clinical outcomes. Previous studies have found that septic patients without fever are more likely to die than those with fever, due to delay in antibiotic administration. To determine whether antibiotic treatment and mortality differed in afebrile adult patients presenting to the Emergency Department with bacteraemia, compared with those with a history of fever. Retrospective six-month audit of all adult patients with positive blood cultures taken in the Emergency Department (ED) of a single tertiary hospital. Outcomes included receipt of antibiotics within 4 and 24 h of ED arrival, in-hospital mortality and 30-day mortality. 227 patients with clinically significant bacteraemia were identified, of which 38 (16.7%) were afebrile in ED. There was no statistically significant difference in the proportion of afebrile or febrile patients receiving antibiotics within 4-h (44.7% vs 55.6%, p = 0.222) or 24-h (89.5% vs 95.2%, p = 0.163) of arrival at ED. Inpatient mortality was not statistically different in the afebrile and febrile groups 15.8% vs 6.9%, p = 0.070), but 30-day mortality was higher among afebrile patients (27.6% vs 10.1%, p = 0.010). There was no significant difference in receipt of antibiotics within 4 h or 24 h ED arrival between the febrile and afebrile groups. However, afebrile patients experienced higher 30-day mortality. While most bacteraemic patients received antibiotics within 24 h, only half received antibiotics within 4 h, representing a key area for improvement. This article is protected by copyright. All rights reserved.
DOI: 10.1111/imj.14938
ORCID: 0000-0001-6672-0578
PubMed URL: 32542931
Type: Journal Article
Subjects: Bacteremia
Communicable Diseases
Emergency Medicine
Appears in Collections:Journal articles

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