(1621) The Phenotype of Bacteremia Admitted From the Emergency Department That Requires Surgery

Introduction: Bacteremia is associated with increased mortality across many emergent disorders. Its contribution to outcome is poorly quantified. Clinical suspicion of bacteremia from Emergency Department (ED) patients (pts) impacts diagnostic and therapeutic management. The clinical presentation of pts who undergo surgery during their admission may vary depending on factors such as pain, comorbidities, and surgical insult type. We aimed to identify a clinical phenotype pattern that may indicate bacteremia in ED-admitted pts who underwent surgery during their hospitalization.

Methods: We conducted an observational cohort study of ED pts 18 years and older presenting from 07/2021 to 12/2023 to an urban tertiary teaching hospital. Pts were included if they had blood cultures obtained and required surgery during their admission. We identified phenotypes of surgical pts with bacteremia based on demographics, comorbidities, vital signs, and laboratory evaluations using SPSS Version 25.

Results: We examined 1058 ED pts with blood cultures that underwent surgery following their ED presentation. Surgical pts with ED bacteremia (232, 22.3%) had similar demographics to all ED pts with blood cultures. Surgical pts with ED bacteremia have significantly more co-morbid conditions such as chronic and end-stage renal disease, diabetes mellitus, and steroid use. Surgical pts with ED bacteremia had more systemic inflammatory response syndrome criteria (tachycardia, tachypnea, abnormal temperatures, and white blood cell counts) and mental status changes. The quick SOFA score was noted to be more abnormal in surgical pts at baseline. Initial laboratory values (first measured ED values) such as lactate, electrolytes (Na+, K+), renal function, and hematologic markers were more abnormal in pts with bacteremia who underwent surgery.

Conclusions: ED pts with bacteremia who require surgery have a distinct clinical phenotype which is existing at ED presentation. Recognizing this may improve the fidelity of diagnostic and therapeutic decisions such as surgery, antibiotic treatment, and resuscitation. More research is needed to eventually use the surgical bacteremia phenotype for early pt identification. Limitations are the observational and ED subgroup nature of the data, and not controlling for the timing of interventions.