Bacteriemia en pacientes adultos dados de alta en el servicio de urgencias / Bacteraemia in adult patients discharged from Emergency department

INTRODUCCIÓN: La bacteriemia constituye un marcador de gravedad de los procesos infecciosos. Sin embargo, en ocasiones se extraen hemocultivos en urgencias a pacientes que son dados de alta estando pendiente su resultado. MATERIAL Y MÉTODOS: Estudio prospectivo de las bacteriemias de la población adulta del servicio de urgencias de un hospital universitario de tercer nivel de marzo de 2014 a febrero de 2015. Se analizaron las características epidemiológicas, clínicas y microbiológicas de los pacientes con bacteriemia que ingresaron y de los que fueron dados de alta. Tras la detección de la bacteriemia, el servicio de microbiología avisó telefónicamente al médico responsable del paciente (paciente ingresado) o al médico de atención primaria (paciente dado de alta). RESULTADOS: Se incluyeron 429 episodios de bacteriemia. Fueron dados de alta el 13,52%. Estos pacientes eran más jóvenes (68,5 vs 73,59 años; p = 0,0001), tenían menor índice de Charlson (1,603 vs 2,309; p = 0,0013) y menor gravedad (shock séptico 0 vs 34, p < 0,0001) que los pacientes que fueron ingresados. Tras la llamada a atención primaria se inició antibiótico oral en el 10,3%, se cambió el antibiótico oral en el 6,9%, fueron ingresados el 12% y el resto continuaron el tratamiento pautado. No se registró mortalidad a los 30días. CONCLUSIONES: Los pacientes dados de alta representan un número considerable. Remitir a un paciente con hemocultivos cursados desde urgencias a domicilio, en situación de estabilidad clínica, es una práctica segura, siempre que exista una reevaluación del paciente en caso de positividad de los mismos

INTRODUCTION: Bacteraemia is a marker of severity of infectious processes. However, sometimes in Emergency Department blood cultures are drawn from patients who are discharged without results being available. MATERIAL AND METHODS: Prospective study of bacteraemia was conducted on adult patients from Emergency Department of tertiary university hospital from March 2014 to February 2015. Epidemiological, clinical and microbiological data were collected from patients admitted and discharged. After the detection of bacteraemia, the microbiology department telephoned the physician responsible (patients admitted) or Primary Care physician (patients discharged). RESULTS: A total of 429 episodes of bacteraemia were included, of which 13.52% were discharged. These patients were younger (68.5 vs 73.59 years, P=.0001), had a lower Charlson index (1.603 vs 2.309, P=.0013) and lower severity (septic shock 0 vs 34; P<.0001) than admitted patients. After the call to Primary Care, oral antibiotics were started in 10.3%, a change in oral antibiotic in 6.9%, 12% were admitted to hospital, and the rest of them continued same treatment. The 30-day mortality rate was 0%. CONCLUSIONS: There was a significant number of patients with bacteraemia were discharged from Emergency Department. To discharge a clinically stable patient with blood cultures taken in Emergency Department is safe, if there is a re-assessment of the patient if these cultures are positive

[Bacteraemia in adult patients discharged from Emergency department]. / Bacteriemia en pacientes adultos dados de alta en el servicio de urgencias.

INTRODUCTION: Bacteraemia is a marker of severity of infectious processes. However, sometimes in Emergency Department blood cultures are drawn from patients who are discharged without results being available. MATERIAL AND METHODS: Prospective study of bacteraemia was conducted on adult patients from Emergency Department of tertiary university hospital from March 2014 to February 2015. Epidemiological, clinical and microbiological data were collected from patients admitted and discharged. After the detection of bacteraemia, the microbiology department telephoned the physician responsible (patients admitted) or Primary Care physician (patients discharged). RESULTS: A total of 429 episodes of bacteraemia were included, of which 13.52% were discharged. These patients were younger (68.5 vs 73.59 years, P=.0001), had a lower Charlson index (1.603 vs 2.309, P=.0013) and lower severity (septic shock 0 vs 34; P<.0001) than admitted patients. After the call to Primary Care, oral antibiotics were started in 10.3%, a change in oral antibiotic in 6.9%, 12% were admitted to hospital, and the rest of them continued same treatment. The 30-day mortality rate was 0%. CONCLUSIONS: There was a significant number of patients with bacteraemia were discharged from Emergency Department. To discharge a clinically stable patient with blood cultures taken in Emergency Department is safe, if there is a re-assessment of the patient if these cultures are positive.

Gastroenteritis bacteriana en un área de Zaragoza (España) / Bacterial gastroenteritis in an area of Zaragoza (Spain)

Objetivo: las infecciones agudas del tracto gastrointestinal figuran entre las enfermedades infecciosas más frecuentes en atención primaria. La participación de los distintos microorganismos difiere de unas áreas geográficas a otras, con variaciones estacionales y según el grupo de población estudiada. El objetivo de este trabajo es estudiar retrospectivamente los coprocultivos y la investigación de toxina A/B de Clostridium difficile realizados de 2010 a 2012 en el Hospital Universitario Miguel Servet (Zaragoza, España) en pacientes pediátricos, que recibe las muestras de la población del área II de Zaragoza. Materiales y métodos: se recibieron 24 058 heces para coprocultivo (46,6% de Pediatría) y 4132 para investigación de toxina (3,4% de Pediatría). Resultados: el 9,6% de los coprocultivos fueron positivos para una o varias bacterias enteropatógenas (el 14,8% de las muestras de adultos y el 5,1% de las muestras pediátricas). El 5% de las determinaciones de toxina A/B de C. difficile fueron positivas (8,6% de las muestras pediátricas y 4,9% de las muestras de adultos). Conclusiones: las bacterias más frecuentemente aisladas, tanto en niños como en adultos, fueron Campylobacter (el 49,9% de los positivos en niños y el 37,1% en adultos) y Salmonella (el 33,8% de los positivos en niños y el 32,9% en adultos). La especie más frecuente de Campylobacter fue Cam- pylobacter jejuni y el serotipo de Salmonella más habitual fue Salmonella enteritidis (AU)

Objective: acute gastrointestinal infections are one of the most frequent infectious diseases in primary health care. Implication of microorganisms is variable in different geographical areas, according to seasonal period and population studied. The aim is to study retrospectively the stool cultures and the Clostridium difficile toxin A/B performed from 2010 to 2012 in the Hospital Miguel Servet (Zaragoza, Spain) of paediatric patients from the area II of Zaragoza. Materials and methods: 24058 faeces were received for culture (46.6% from children) and 4132 faeces for toxin investigation (3.4%from children). Results: 9.6% of the stool cultures were positive for one or more enteropathogen bacteria (14.8% from adults and 5.1% from children). Five percent of the toxin investigations were positive (8.6% from children and 4.9 % from adults). Conclusions: The bacteria most frequently isolated in both adults and children were Campylobacter (49.9% of the positives in children and 37.1% in adults) and Salmonella (33.8% of the positives in children and 32.9% in adults). The most frequent serotype of Salmonella was Salmonella enteritidis and the most frequent species of Campylobacter was Campylobacter jejuni (AU)