[Community bacteremia ambulatory treated or identified after discharge from the emergency department].
OBJECTIVE
The patients with bacteremia usually require hospital admission. In occasions they are remitted to their home, due to inappropriate diagnosis or rapid clinical improvement. The study describes the evolution and the interventions carried out in patients with community bacteremia that were remitted to their home.


METHODS
Prospective observational study carried out in a university hospital, of 450 beds, from March of 2000 until December of 2003. The hospital has a team that daily evaluated all blood cultures practiced; the patients with bacteremia remitted to home from the Emergency Department with inappropriate antibiotic were identified.


RESULTS
During the period of study 1,172 episodes of true bacteremia were diagnosed, of these 247 (21.1%) were remitted to their home. In 50 cases (20.2%) it was considered necessary to contact with the patient: 36 for inappropriate empiric antibiotic treatment, 12 without antibiotic treatment and 2 for lack of information. Antibiotic treatment was initiated or modified in 34 cases, and 10 required hospital admission. Excluding the 66 patients who died in the first 48 h, the crude mortality of the patients remitted to home was inferior (4%) to that of the patients that required hospital admission (11.9%).


CONCLUSIONS
One fifth of community bacteremia were ambulatory treated, frequently the antibiotic treatment was inappropriate, it is necessary to guarantee an appropriate control of this population.
Terradas
Roser
R
Servicio de Evaluación y Epidemiología Clínica. Hospital del Mar. Barcelona. España.
Grau
Santiago
S
Knobel
Hernando
H
Alvarez-Lerma
Francisco
F
Riu
Marta
M
Salvadó
Margarita
M
D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D001769:Blood / Q000382:microbiology; D017714:Community-Acquired Infections; D003627:Data Interpretation, Statistical; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies
D000900:Anti-Bacterial Agents