No better outcome of using antibiotic broadly in hospitalized adult patients with leukocytosis in emergency department

Abstract

Background: Leukocytosis is a common laboratory finding in emergency departments worldwide. Various infectious diseases are common causes of leukocytosis in hospitalized adult patients. Most emergency physicians have a high awareness of sepsis or severe infection, which requires empirical antibiotics. However, there are many other etiologies for leukocytosis. The outcome of prescribing broad-spectrum antibiotics in the emergency department for leukocytosis patients is not well-understood. Objectives: Our objectives were to determine whether prescribing antibiotics in the emergency department affect outcome for hospitalized adult patients with leukocytosis. Methods: A retrospective cohort study of hospitalized adult emergency department patients with leukocytosis was conducted in a tertiary hospital in Taiwan between June 2016 and June 2017. Patients with leukocytosis (white blood cell count >11,000 cells per μL) who were admitted via the emergency department at the Kaohsiung Veterans General Hospital, from June 2016 to June 2017 were enrolled. Patients aged ⩽18 years, pregnant women, those who received prophylactic antibiotics prior to operation, and those with a final diagnosis of hematologic malignancy were excluded from this study. The primary outcome measure was hospital stay, and the secondary outcome measure was mortality. All collected data were statistically analyzed. Results: A total of 8054 hospitalized adult patients with leukocytosis were included (the exclusion criteria included patients aged ⩽18 years, pregnant women, those who received prophylactic antibiotics prior to surgery, and those with a final diagnosis of hematologic malignancy); all patients were admitted via the emergency department. In all, 4486 patients received initial antibiotic treatment in the emergency department, whereas 3568 patients did not receive antibiotics in the emergency department and ward/intensive care unit within 3 days. There was no statistically significant difference in hospital days (p = 0.239) or mortality (p = 0.345) between those who received and did not receive antibiotics in the emergency department. Conclusion: Hospitalized adult patients with leukocytosis did not necessarily require antibiotics in the emergency department except when they had a differential diagnosis that requires antibiotic treatment.