title: Different clinical presentation of community-onset bacteremia among neutropenic adults in the ED.
abstract: OBJECTIVE
  To analyze the differences in clinical presentation and characteristics of community-onset bacteremia between neutropenic and nonneutropenic adults visiting the emergency department.
  
  
  METHODS
  A case-control study with a ratio of 1:2 was conducted retrospectively over a 6-year period. Demographic characteristics, microorganisms, severity of illness, and clinical outcomes determined from medical records were analyzed.
  
  
  RESULTS
  In total, 116 neutropenic adults (case patients) and 232 nonneutropenic adults (control patients) were examined. Significant differences in the source of bacteremia, susceptibility, and species of bacteremia-causing organisms between the case patients and control patients were observed by univariate analyses. Significantly more patients presenting with an initial syndrome of severe sepsis or septic shock at the emergency department, having high Pittsburgh bacteremia scores (≥4 points) or having severe comorbidities (McCabe classification), and high 28-day mortality rates were discovered in the case group, compared with the control group. Of note, Pseudomonas aeruginosa (32/137 [23.4%] vs 8/272 [2.9%], P < .001) was more often isolated from the case patients. In a further analysis using a multivariate regression to demonstrate the independent predictors of P aeruginosa infection, patients with neutropenia remained as an independent risk factors (odds ratio, 7.48; P < .001).
  
  
  CONCLUSIONS
  This study demonstrated obvious differences of community-onset bacteremia in severity, the distribution of microorganisms, and susceptibility between neutropenic and nonneutropenic patients. Antipseudomonas therapy was empirically suggested for neutropenic patients with community-onset bacteremia and reducing the need for a glycopeptide.
authors.affiliation: Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Hsieh
authors.affiliation: Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Tsung-Yu
authors.initials: TY
authors.lastname: Chan
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Ming-Yuan
authors.initials: MY
authors.lastname: Hong
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Chi
authors.affiliation: Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D017714:Community-Acquired Infections; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology; D009503:Neutropenia / Q000453:epidemiology* / Q000209:etiology; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents