Hemocultivo temprano como factor pronóstico en pacientes con diagnóstico de sepsis que ingresan al área de reanimación del servicio de urgencias del Hospital General Regional No. 1 Carlos Mac Gregor Sánchez Navarro

Abstract

INTRODUCTION: There are no guides or guidelines, in the area of emergency, to establish the patient characteristics that require for taking blood cultures. The initial treatment of sepsis must be oriented to the previous knowledge of micro-organisms that are prevalent in the community. Detection of an specific etiologic agent allows the reasoned choice of antibiotic drug that might reduce the hospital staying, the daily dose of the antibiotic and the hospital costs. OBJECTIVE: This study will try to establish whether the taking of blood culture early at the entry of the patient and the eventual isolation of the germ which produce sepsis improves survival and/or the clinical evolution of patients with diagnosis of sepsis, severe sepsis or septic shock. The present study was conducted on the reanimation unit of the emergency service at the HRG service unit No. 1 "Carlos Mac Gregor Sánchez Navarro". MATERIAL AND METHODS: A prospective, not experimental, analytical, observational study of not concurrent cohort was made. Patients age 18 or older were included in the study. Male or female that entered the area of emergency with diagnosis of sepsis, severe sepsis or septic shock were included. Exclusion criteria were: patients who do not have complete clinical record, patients who did not obtain a blood culture early. Elimination criteria were: patient that during the medical reevaluation was considered that the systemic inflammatory response syndrome is secondary to a different process to the infection. The study was conducted between the period Of December to Febrary of 2011. Prospective results were compared to historical controls, i.e. with the data obtained from clinical files of the Hospital, with the same diagnosis in the period from 1 May to 31 October 2010. RESULTS: It was analyzed a total of 134 patients of which 60 were hemocultivated (Group A) and 74 were not (Group B) and they were not exposed to the maneuver of intervention. Sixteen patients with positive blood cultures were obtained from the 60 patient’s hemocultivated (26.6%). Of these patients only 4 cases requiring change in the treatment (25%), in 12 patients (75%), the rest of the sample, it did not require change of antibiotic, since the administered initially turned out to be effective. The average age of the Group A was 63.13 years and for Group B of 69.76 (p < 0.05). The gender of the groups split in 47.8% for male and 52.2% for the female. The percentage of comorbidity was similar between the two groups. The diagnoses between groups were different with Sepsis 56.7% (A) vs 75.7% (B), severe Sepsis 16.7% (A) vs 18.9% (B), septic shock 26.7% (A) vs. 5.4% (B). The organic systems involved with more frequency were, the urinal and the respiratory, there were no statistically differences between groups. Overall mortality was 43.3% (A) and 43.2% (B) (p>0.05). In relation to the hospital staying, the group A present an average of 6.5 days and the group B of 11.89 days (p < 0.05). There were no statistically significant differences regarding the co-morbidities with the organ or system involved, to the development of sepsis and the gender. Group B presented older patients. The length of hospital staying was lower for the group of patients who were subjected to the maneuver of intervention (Group A). CONCLUSIONS: It is necessary to develop more studies to evaluate the cost benefit of hemocultives. It is true that group A presented a shorter hospital stay that controls, however, only in the 6.6% of the cases a therapeutic behavioral change was made.