title: Audit of aspects of practice in relation to patients with suspected community-onset blood stream infection.
abstract: BACKGROUND
  Community-onset blood stream infection (C-BSI) is an important cause of sepsis. The urinary tract is an important source for C-BSI. Urinary catheters are a recognized risk factor. Blood culture is the critical diagnostic test. Prompt effective antimicrobial therapy is a key intervention. We reviewed practice in relation to patients presenting with suspected C-BSI.
  
  
  OBJECTIVE
  To review practice in relation to patients presenting with suspected C-BSI.
  
  
  METHODS
  Patients were those with blood cultures (BC) submitted from the emergency department over 4 weeks. Details were recorded from laboratory and patient records. Data were analysed in SPSS.
  
  
  RESULTS
  BC were taken from 201 patients. Suspected source was respiratory (32.8%), urine (14.9%) or other (52.3%). 9 (4.5%) patients had urine catheters. Urine was the suspected source of infection in five of these. Bacteriuria was present in seven of these nine from whom urine samples were submitted though it was polymicrobial in all but 2. Median time from registration to first administration of an antimicrobial was 226 min and was broadly guideline compliant in 121 (80.7%) of 151 patients who received treatment. BC were positive in 17 (8.5%) of which 10 (5.0%) were significant (mainly Escherichia coli).
  
  
  CONCLUSIONS
  Suspected C-BSI is common. E. coli is the leading pathogen. Urine is a common suspect source. Urinary catheters are present in 4.5%. Median time to first dose of antimicrobial treatment is almost 4 h suggesting scope to expedite patients transition from presentation to intervention.
authors.affiliation: School of Medicine, National University of Ireland Galway, Galway, Ireland. m.reza1@nuigalway.ie.
authors.forename: M A
authors.initials: MA
authors.lastname: Reza
authors.affiliation: School of Medicine, National University of Ireland Galway, Galway, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Cormican
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult
keywords: Bloodstream infection; Community acquired infection; E. coli; Urine catheters