Incidence of Multidrug Resistant Infections in Emergency Department Patients with Suspected Sepsis

Oxman, David; Lohr, Kristin; Gupta, Ena; Madara, John; Len, Edward; Hseih, Jerry

doi:10.1016/j.amjms.2020.07.019

Cited by 6 publications

(12 citation statements)

References 25 publications

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“…The incidence of MDRO at hospital admission in our study (9.8%) is slightly lower than observed in a United States study (12.0%) 34 and an Italian study (17.0%) 1 that also included patients with sepsis coming from the community. In a study that evaluated only patients with urinary tract infections presented to an ED, the prevalence of MDRO at hospital admission (6.7%) was lower than observed in our study.…”

Section: Discussioncontrasting

confidence: 80%

“…At the same time, GNB infections were uncommon, and carbapenemases-producing Enterobacterales was isolated in only one patient. 34 In another study that included only patients with pneumonia presenting to the ED, MRSA was the most prevalent MDRO. 11 …”

Section: Discussionmentioning

confidence: 99%

“…It is essential to note that previous studies that evaluated factors associated with MDRO in patients with community-acquired infections did not assess the hospital unit that referred to the ICU admission or included only patients admitted from the ED. 1 , 21 , 34 , 38 , 41 , 49–51 …”

Section: Discussionmentioning

confidence: 99%

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Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects on Hospital Mortality

Maia¹,

Silveira²,

Gomes³

et al. 2023

IDR

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Purpose To evaluate the effect of MDRO infection on hospital mortality and the risk factors among critically ill patients with sepsis at hospital admission. Patients and Methods A cross-sectional study was performed between April 2019 and May 2020, followed by a cohort to evaluate hospital mortality that prospectively included all consecutive patients 18 years or older with sepsis admitted within 48 hours of hospital admission to an adult ICU in Brazil. Patients’ characteristics, blood samples within one hour of ICU admission, and microbiological results within 48h of hospital admission were collected. In addition, descriptive statistics, binary logistic regression, and propensity score matching were performed. Results At least one MDRO was isolated in 85 patients (9.8%). The extended-spectrum beta-lactamase-producing Enterobacterales are the most frequent organism (56.1%). Hypoxemic acute respiratory failure (OR 1.87, 95% CI 1.02–3.40, p = 0.04), Glasgow Coma Score below 15 (OR 2.57, 95% CI 1.38–4.80, p < 0.01), neoplasm (OR 2.66, 95% CI 1.04–6.82, p = 0.04) and hemoglobin below 10.0 g/dL (OR 1.82, 95% CI 1.05–3.16, p = 0.03) were associated with increased MDRO. Admission from the Emergency Department (OR 0.25, 95% CI 0.14–0.43, p < 0.01) was associated with decreased MDRO. In the multivariate analysis, MDRO at hospital admission increased hospital mortality (OR 2.80, 95% CI 1.05–7.42, p = 0.04). After propensity score-matching adjusted to age, APACHE II, SOFA, and dementia, MDRO at hospital admission was associated with significantly high hospital mortality (OR 2.80, 95% CI 1.05–7.42, p = 0.04). The E-value of adjusted OR for the effect of MDRO infection on hospital mortality was 3.41, with a 95% CI of 1.31, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect. Conclusion MDRO infection increased hospital mortality, and MDRO risk factors should be accessed even in patients admitted to ICU within 48 hours of hospital admission.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects on Hospital Mortality

Maia¹,

Silveira²,

Gomes³

et al. 2023

IDR

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“…χ 2 test was used to compare the non-grade count data between groups; logistic regression analysis was used for multivariate analysis; test level α=0.05. evaluate the prognosis of patients with cardiovascular and cerebrovascular diseases and its score is positively correlated with the mortality of patients [5] . The rapid emergency medicine score (REMS) is also an emergency critical scoring system.…”

Section: Statistical Processingmentioning

confidence: 99%

The Evaluation Value of Emergency and Critical Illness Scoring System for Emergency Medical Patients

Xiong¹,

Rong²,

Zhao³

et al. 2021

ijps

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Xiong et al.: Critical Illness Scoring System for Emergency Medical PatientsTo explore the application value of three emergency and critical illness scoring systems in the prognosis assessment of emergency medical patients is the main objective. The 200 emergency medical cases received in the emergency department of our hospital were selected as the research objects and the 28 d survival of the patients was used as the observation end point. The patients were divided into the survival group 156 cases and the death group 44 cases; statistical analysis of the rapid emergency treatment within 24 h of admission to the two groups; differences in rapid emergency medicine score, modified early warning score, acute physiology and chronic health evaluation II score, statistical analysis of the general physiological indicators and general data of the two groups of patients within 24 h of admission; the work of subjects, receiver operating characteristic curve was used to analyze the differences between the three scoring systems in predicting the prognosis of emergency medical patients and the logistic multivariate regression model was used to analyze the relevant factors affecting the prognosis of patients. The rapid emergency medicine score, modified early warning score and acute physiology and chronic health evaluation II score of the death group were higher than those of the survival group and the difference was statistically significant (p<0.05); the rapid emergency medicine score of the death group predicted the 28 d death of emergency medical patients and the area under the receiver operating characteristic curve was 0.722. The area under the curve value under the receiver operating characteristic curve for modified early warning score predicting 28 d death of emergency medical patients was 0.689 and the area under the curve value under receiver operating characteristic curve for predicting 28 d death of emergency medical patients by acute physiology and chronic health evaluation II score was 0.842; the 28 d prognostic outcome of patients was used as the dependent variable to establish a logistic regression model. Factor analysis showed that the older the patient, circulatory system disease, neurological disease, intensive care unit enrollment, basic disease types >2, decreased saturation of peripheral oxygen and unresponsiveness were independent risk factors for 28 d death in patients admitted to the emergency medical department (p<0.05). For patients admitted to the emergency medical department, rapid emergency medicine score, modified early warning score and acute physiology and chronic health evaluation II score have certain clinical value in predicting the prognosis of patients at 28 d and the value of acute physiology and chronic health evaluation II score is relatively high. There are many factors affecting the prognosis of patients and they affect the adverse effects of patients in emergency medical department and there are many factors for the prognostic outcome.

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“…In this issue of AJMS, Oxman et al 4 examine the rate of multidrug resistant bacteremia among ED patients with suspected sepsis and discuss the results in relation to the optimal approach to empiric prescribing of antibiotics. We commend the authors for contributing to such a critically important antibiotic stewardship topic.…”

mentioning

confidence: 99%

Empiric Antibiotic Prescribing for Suspected Sepsis: A Stewardship Balancing Act

Pulia

Redwood

2020

The American Journal of the Medical Sciences

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Incidence of Multidrug Resistant Infections in Emergency Department Patients with Suspected Sepsis

Cited by 6 publications

References 25 publications

Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects on Hospital Mortality

Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects on Hospital Mortality

The Evaluation Value of Emergency and Critical Illness Scoring System for Emergency Medical Patients

Empiric Antibiotic Prescribing for Suspected Sepsis: A Stewardship Balancing Act

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