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The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting

Published online by Cambridge University Press:  30 March 2016

Christer Axelsson ,
Johan Herlitz ,
Anders Karlsson ,
Henrik Sjöberg ,
Maria Jiménez-Herrera ,
Angela Bång ,
Anders Jonsson ,
Anders Bremer Open the ORCID record for Anders Bremer [Opens in a new window] ,
Henrik Andersson  and
Martin Gellerstedt
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Christer Axelsson*
Affiliation:
Faculty of Caring Science, Working Life and Social Welfare, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden
Johan Herlitz
Affiliation:
Faculty of Caring Science, Working Life and Social Welfare, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden
Anders Karlsson
Affiliation:
Ambulance Service Sothern, Älvsborg Hospital, Borås, Sweden
Henrik Sjöberg
Affiliation:
Ambulance Service Sothern, Älvsborg Hospital, Borås, Sweden
Maria Jiménez-Herrera
Affiliation:
Nursing Department, Universitat Rovira I Virgili, Tarragona, Spain
Angela Bång
Affiliation:
Faculty of Caring Science, Working Life and Social Welfare, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden
Anders Jonsson
Affiliation:
Faculty of Caring Science, Working Life and Social Welfare, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden
Anders Bremer
Affiliation:
Faculty of Caring Science, Working Life and Social Welfare, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden
Henrik Andersson
Affiliation:
Faculty of Caring Science, Working Life and Social Welfare, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden
Martin Gellerstedt
Affiliation:
Faculty of Economy and IT, West University, Trollhättan, Sweden
Lars Ljungström
Affiliation:
Infektion Disease Department, Skaraborg Hospital, Skövde, Sweden
*
Correspondence: Christer Axelsson, RN Associate Professor in Prehospital Care Faculty of Caring Science Working Life and Social Welfare University of Borås SE-501 90 Borås, Sweden E-mail: christer.axelsson@hb.se
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Abstract

Purpose

There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.

Basic Procedures

All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.

Main Findings/Results

In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.

The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).

Conclusion

Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.

AxelssonC, HerlitzJ, KarlssonA, SjöbergH, Jiménez-HerreraM, BångA, JonssonA, BremerA, AnderssonH, GellerstedtM, LjungströmL. The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting. Prehosp Disaster Med. 2016;31(3):272–277.

Keywords

bacteremiaEmergency Medical Servicesprehospital phasesepsis
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 3 , June 2016 , pp. 272 - 277
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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