Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department

Chan-Peng Hsu,Po-Han Wu,Jui-Yuan Chung,Hsin-Yu Chen,Jiann-Hwa Chen,Wei-Lung Chen,Chien-Cheng Huang

doi:10.1186/s12879-020-05758-1

Abstract

BackgroundEarly detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis (a potentially fatal condition caused by the body’s response to an infection), may benefit a patient’s outcome, since the mortality rate increases by 5–10% for each hour of delayed therapy. Unfortunately, GNB diagnosis is based on bacterial culture, which is time consuming. Therefore, an economic and effective GNB (defined as a positive blood, sputum, or urine culture) infection detection tool in the emergency department (ED) is warranted.MethodsWe conducted a retrospective cohort study in the ED of a university-affiliated medical center between January 01, 2014 and December 31, 2017. The inclusion criteria were as follows: (1) age ≥ 18; (2) clinical suspicion of bacterial infection; (3) bacterial culture from blood, sputum, or urine ordered and obtained in the ED. Descriptive statistics was performed on patient demographic characteristics, vital signs, laboratory data, infection sites, cultured microorganisms, and clinical outcomes. The accuracy of vital signs to predict GNB infection was identified via univariate logistic regression and receiver operating characteristic (ROC) curve analysis.ResultsA total of 797 patients were included in this study; the mean age was 71.8 years and 51.3% were male. The odds ratios of patients with body temperature ≥ 38.5 °C, heart rate ≥ 110 beats per minute, respiratory rate ≥ 20 breaths per minute, and Glasgow coma scale (GCS) < 14, in predicting GNB infection were found to be 2.3, 1.4, 1.9, and 1.6, respectively. The area under the curve values for ROC analysis of these measures were 0.70, 0.68, 0.69, and 0.67, respectively.ConclusionThe four physiological parameters were rapid and reliable independent predictors for detection of GNB infection.

Highlights

Detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis, may benefit a patient’s outcome, since the mortality rate increases by 5–10% for each hour of delayed therapy
Severe Inflammatory Response Syndrome (SIRS) is defined as a heart rate > 90 beats per minute, respiratory rate > 20 breaths per minute, temperature < 36 °C or > 38 °C, white blood cell count < 4000 / mm3 or > 12,000 / mm3, and band form > 10% [11]. quick sepsisrelated organ failure assessment (qSOFA) score is defined as systolic blood pressure ≤ 100 mmHg, respiratory rate ≥ 22 breaths per minute, and Glasgow Coma Scale < 15 [8]
This study identified the key clinical physiological parameters that could predict GNB infection in the emergency department (ED) by reviewing medical records of adult patients with suspected bacterial infection, according to the definition mentioned in the Methods

Summary

Introduction

Detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis (a potentially fatal condition caused by the body’s response to an infection), may benefit a patient’s outcome, since the mortality rate increases by 5–10% for each hour of delayed therapy. Bacteria invade blood vessels and produce inflammatory mediators that circulate throughout the body, resulting in systemic inflammation and multiple organ failure. Bacteria and their endotoxins induce local inflammation in extravascular tissues that release immune mediators into the bloodstream [2]. The qSOFA score includes only three clinical parameters: respiratory rate, altered mental status, and systolic blood pressure [8]

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Methods

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Discussion

Conclusion