The prevalence of bacteremia in out of hospital cardiac arrest patients presenting to the emergency department of a tertiary care hospital

Figures & data

Table 1. Patient characteristics and prehospital variables.

*Continuous variables are reported as Mean ± SD, categorical variables as N(%)
Patient characteristics	Bacteremic (n = 93)	Non-bacteremic (n = 107)	p-Value
Age	71.3 ± 16.9	70.1 ± 17.3	.6
Gender: Female	26 (28.0)	34 (31.8)	.6
Male	67 (72.0)	73 (68.2)
Hypertension	59 (63.4)	64 (59.8)	.6
Coronary Artery Disease	40 (43.0)	41 (38.3)	.5
Atrial Fibrillation	6 (6.5)	7 (6.5)	.9
Diabetes Mellitus	32 (34.4)	34 (31.8)	.7
Dyslipidemia	18 (19.4)	24 (22.4)	.6
Chronic Heart Failure	19 (20.4)	18 (16.8)	.5
Active Malignancy	12 (12.9)	17 (15.9)	.6
Chronic Kidney Disease	10 (10.8)	12 (11.2)	.9
Chronic Obstructive Pulmonary Disease /Emphysema	5 (5.4)	13 (12.1)	.9
Cerebrovascular Accident	8 (8.6)	6 (5.6)	.4
Interval Time (Arrest to ED presentation) (min)	30.6 ± 19.4	26.4 ± 19.9	.2
Location of the arrest			.5
Home/Residence	74 (79.6)	74 (69.2)
Public building/ Street/Highway	16 (17.2)	24 (22.4)
Others*	3 (3.3)	9 (8.4)
Arrest witnessed	73 (80.2)	89 (84.8)	.4
Bystander CPR initiated	88 (94.6)	93 (86.9)	.1
AED usage
AED used	41 (50.6)	39 (48.8)	.8
AED not used	40 (49.4)	41 (51.2)
First rhythm(prehospital)
Shockable Rhythm	11 (34.4)	6 (30.0)	.9
Non-shockable Rhythm	19 (59.4)	12 (60.0)
Missing Rhythm	2 (6.3)	2 (10.0)
ROSC achieved (prehospital)	5 (5.4)	2 (1.9)	.3
Acute Coronary Syndrome symptoms
Presyncope	10 (10.8)	13 (12.1)	.8
Gastrointestinal symptoms	15 (16.1)	20 (18.7)	.6
Diaphoresis	5 (5.4)	19 (17.8)	.007
Shortness of breath	26 (28.0)	43 (40.2)	.07
Pain or discomfort in the chest	17 (18.3)	30 (28.0)	.1
Pain or discomfort elsewhere	6 (6.5)	11 (10.3)	.3
Other	1 (1.1)	7 (6.5)	.07
Infection variables
Current antibiotic use	8 (10.3)	12 (13.0)	.6
Pulmonary infection	19 (20.4)	26 (24.3)	.5
Fever	9 (9.7)	14 (13.1)	.5
Urinary tract infection	4 (4.3)	6 (5.6)	.8
Gastrointestinal infection	7 (7.5)	10 (9.3)	.7
Skin infection	3 (3.2)	1 (0.9)	.3

Table 1 shows the patient characteristics and prehospital variables of both bacteremic and non-bacteremic out of hospital cardiac arrest patients.

ED: emergency department; AED: automated external defibrillator; CPR: Cardiopulmonary Resuscitation; ROSC: Return of Spontaneous Circulation.

Figure 1. Flowchart.

Table 2. Initial rhythm and lab parameters upon presentation to the ED.

*Continuous variables are reported as Mean ± SD, categorical variables as N(%)
Lab parameters upon presentation to the ED	Bacteremic (n = 93)	Non-bacteremic (n = 107)	p-Value
Initial Rhythm in the ED
Shockable Rhythm	12 (12.9)	10 (9.3)	.3
Non-shockable Rhythm	77 (82.8)	87 (81.3)
Missing Rhythm	4 (4.3)	10 (9.3)
Labs
WBC/cu.mm	19398 ± 43771	15618 ± 16723	.4
BUN (mg/dL)	42 ± 34	30 ± 23	.003
Creatinine (mg/dL)	2.2 ± 1.8	1.5 ± 0.9	.002
Sodium (mmol/L)	140.8 ± 11	141.3 ± 10.7	.8
Potassium (mmol/L)	6.2 ± 1.5	5.9 ± 1.6	.1
Chloride (mmol/L)	97.8 ± 9.0	97.3 ± 8.6	.7
Bicarbonate (mmol/L)	17.6 ± 7.9	18.1 ± 7.2	.7
Magnesium (mg/dL)	3.1 ± 1.7	2.7 ± 0.6	.02
Phosphate (mg/dL)	8.5 ± 3.5	8.1 ± 2.5	.4
Lactic Acid (mmol/L)	14.3 ± 5.6	14.3 ± 5.5	.9
Troponin T (ng/ml)	0.3 ± 0.6	0.2 ± 0.2	.09
pH Arterial	7.1 ± 0.2	7.0 ± 0.2	.1
PaCO2 (mmHg)	66.3 ± 36.9	78.5 ± 59.2	.2

Table 2 shows the initial rhythm and lab parameters upon presentation to the emergency department of both bacteremic and non-bacteremic out of hospital cardiac arrest patients.

ED: emergency department; WBC: White Blood Cells.

Table 3. Therapeutic parameters and outcomes of patients.

*Continuous variables are reported as Mean ± SD, categorical variables as N(%)
Therapeutic parameters and outcomes of patients	Bacteremic (n = 93)	Non-bacteremic (n = 107)	p-Value
Total epinephrine during resuscitation (mg)	7 ± 6	7 ± 6	.3
Number of shocks	6 ± 8	4 ± 4	.2
CPR time	23.3 ± 10.7	22.9 ± 10.1	.8
Time to first antibiotic (min)	81.0 ± 73.8	93.1 ± 61.3	.8
Time to vasopressor/inotrope initiation (min)	40.9 ± 24.5	33.9 ± 26.2	.3
Vasopressor/inotrope duration (h)	37.1 ± 57.3	41.0 ± 55.9	.8
IV fluid requirement first 6 h (L)	1.5 ± 1.9	1.3 ± 0.8	.08
IV fluid requirement first 24 h (L)	1.7 ± 1.3	1.65 ± 1.29	.8
ROSC in ED	30 (34.1)	50 (44.6)	.1
Temperature after ROSC achieved (°C)	36.7 ± 1.1	36.0 ± 1.0	.5
Systolic blood pressure after ROSC achieved (mmHg)	106.3 ± 35.1	113.3 ± 37.7	.4
Diastolic blood pressure after ROSC achieved (mmHg)	58.7 ± 28.3	67.2 ± 24.4	.2
Heart Rate after ROSC achieved (bpm)	110.3 ± 33.9	102.7 ± 29.5	.3
Respiratory rate after ROSC achieved (/min)	24.1 ± 7.6	20.6 ± 6.4	.06
Oxygen saturation after ROSC achieved (%)	92.2 ± 10.1	94.7 ± 8.1	.3
Time to ROSC (min)	18.8 ± 10.1	15.6 ± 9.7	.2
Glasgow Coma Scale (GCS)
Mild (14)	0 (0)	2 (1.9)	.5
Moderate (8–13)	0 (0)	1 (0.9)
Severe (<8)	93 (100)	104 (97.2)
Cerebral Performance Category (CPC)
Good (1,2)	0 (0)	2 (1.9)	.5
Bad (3,4,5)	93 (100)	105 (98.1)
ED mortality	80 (86.0)	78 (72.9)	.02
28-day mortality	88 (94.6)	97 (90.7)	.4
Hospital mortality	90 (96.8)	97 (90.7)	.08
Disposition
Discharged home or to another facility	0 (0)	3 (2.8)	.4
Transferred to another acute care facility from ED or Floor	3 (3.2)	5 (4.7)
Morgue	90 (96.8)	102 (90.7)
Against Medical Advice	0(0)	2 (1.9)

Table 3 shows the therapeutic parameters and outcomes of both bacteremic and non-bacteremic out of hospital cardiac arrest patients. ED: Emergency Department; CPR: Cardiopulmonary Resuscitation; ROSC: Return of Spontaneous Circulation; IV: Intravenous.

Table 4. Organisms found in the blood and in the urine.

Bacteraemia	Count (N = 93)	Column %
Other Staphylococcus species	28	30.1
Staphylococcus epidermidis	16	17.2
Escherichia coli	10	10.7
Enterococcus species	10	10.7
Other Streptococcus species	8	8.6
Streptococcus viridans	5	5.3
Staphylococcus aureus	3	3.2
Streptococcus aglactiae	3	3.2
Pseudomonas aeruginosa	2	2.2
Streptococcus pneumoniae	1	1.1
Acinetobacter baumannii	1	1.1
Hemophilus species	1	1.1
Proteus mirabilis	1	1.1
Clostridium species	1	1.1
Corynebacterium jeikeium	1	1.1
Klebsiella pneumoniae	1	1.1
Morganella morganii	1	1.1
Urinary Tract Infection*	Count (N = 20)	Column %
Escherichia coli	14	70
Pseudomonas aeruginosa	2	10
Enterococcus species	2	10
Klebsiella pneumoniae	2	10

Table 4 shows the organisms that were isolated in the blood and urine cultures of the bacteremic out of hospital cardiac arrest patients.

Table 5. Logistic regression for Hospital Mortality.

Hospital mortality (reference: No)
Variables	OR ( 95 % CI )	p-Value
Bacteremic	1.3 (0.2 − 8.2)	.8
Antibiotic given during resuscitation	0.6 (0.1 − 3.8)	.6
Lactate	1.2 (1.0 − 1.5)	.1
Variables included in the model were: Bacteremic (reference: no); Age (reference: below 73), gender (reference: female), magnesium, Diabetes (reference: no), Dyslipidemia (reference: no), Cardiac complications (reference:no), antibiotic given during resuscitation (reference:no).

Table 5 shows the multivariate logistic regression showing no association between bacteraemia, antibiotic use during resuscitation, lactate level and hospital mortality in out of hospital cardiac arrest patients who survived their emergency department stay.

Data availability statement

All the data was presented in the form of Tables. Patient information was collected from the electronic medical files of our institution.

The data that support the findings of this study are available from the corresponding author [MES], upon reasonable request.