Predictors for delayed antibiotic administration among bacteraemic patients in the Emergency Department: Differences between medical and surgical interns

Papadimitriou‐Olivgeris, Matthaios; Perdikis, Konstantinos Cédric; Cois, Michela; Roth, L.W.; Mykoniati, Sofia; Nusbaumer, Charly; Duplain, Hervé

doi:10.1111/eci.13324

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…En un segundo paso, se incluyeron los términos (Emergencies OR Emergency OR Emergency Department) y, tercero los términos (Adults) AND (Early). Siendo las estrategias de búsquedas secundarias:(Emergency OR Emergencies OR Emergency department) AND (Source Control) AND (Early) AND (Infection OR Bacterial Infection OR Sepsis) porque no respondían directamente a la pregunta PICO de esta revisión [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65].…”

Section: Métodosunclassified

Early source control of infection in patients seen in the emergency department: a systematic review

Julián-Jiménez,

Lorenzo Álvarez,

Gutiérrez Bueno

et al. 2024

Rev Esp Quimioter

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Introduction and objective. The term source (or focus) control encompasses all those physical measures that can be used to reduce the inoculum and modify those factors in the infectious medium that promote microbial growth or foreign antimicrobial defenses of the host. The main objective of this systematic review (SR) is to know and compare whether early detection and control of the focus (in less than 6 hours) in adult patients treated in the ED for severe infection or sepsis, compared to not controlling the focus or delayed focus control (more than 12 hours) is more effective and safer (improves clinical evolution, mortality, complications, hospital stay or need for ICU admission). Method. A systematic review is carried out following the PRISMA regulations in the databases of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2000 to December 31, 2023 without language restrictions and using a combination of MESH terms: “Source Control”, “Early” “Infection OR Bacterial Infection OR Sepsis”, “Emergencies OR Emergency OR Emergency Department” and “Adults”. Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively. Results. A total of 1,658 articles were identified, of which 2 that met the inclusion criteria and were classified as high quality were finally analyzed. The included studies represent a total of 2,404 patients with 678 cases in which an intervention was performed to control the focus (28.20%). In the first study, 28-day mortality was lower in patients who underwent an intervention to control the focus (12.3% vs. 22.5%; P <0.001), with an adjusted HR of 0.538 (95% CI: 0.389-0.744; P<0.001). In the second, it was demonstrated that the time elapsed from when the patient was evaluated for the first time and was hemodynamically stabilized, until the start of surgery was associated with his survival at 60 days with an OR of 0.31 (95% CI: 0.19-0.45; P <0.0001). In fact, for each hour of delay an adjusted OR of 0.29 (95% CI: 0.16-0.47; P<0.0001) is established. So if the intervention is performed before 2 hours at 60 days, 98% of the patients are still alive, if it is performed between 2-4 hours it is reduced to 78%, if it is between 4-6 hours it drops to 55%, but if it is done for more than 6 hours there will be no survivors at 60 days. Conclusions. This review shows that source control carried out after the evaluation of patients attending the ED reduces short-term mortality (30-60 days) and that it would be advisable to implement any required source control intervention as soon as possible, ideally early (within 6 hours).

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Section: Métodosunclassified

Early source control of infection in patients seen in the emergency department: a systematic review

Julián-Jiménez,

Lorenzo Álvarez,

Gutiérrez Bueno

et al. 2024

Rev Esp Quimioter

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“…Bloodstream infections (BSIs) are a major cause of critical illness and carry a high risk of death [ 1 ]. Timely antimicrobial administration remains the cornerstone of the multifaceted management of bacterial infections [ 2 , 3 ]. Conventional blood cultures and isolation of microorganisms in blood culture are still considered the “gold standard” for diagnosis of BSI [ 4 , 5 ].…”

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confidence: 99%

Early Biomarker-Guided Prediction of Bloodstream Infection in Critically Ill Patients: C-Reactive Protein, Procalcitonin, and Leukocytes

Hertz

Ahlström

Bestle

et al. 2022

Open Forum Infectious Diseases

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Background Bloodstream infections (BSI) often lead to critical illness and death. The primary aim is to determine the diagnostic accuracy of the biomarkers C-reactive protein (CRP), procalcitonin (PCT) and leukocyte count for the diagnosis of BSI in critically ill patients. Material and Methods Nested case-control study based on the ‘Procalcitonin And Survival Study’(PASS) trial (n = 1200). Patients who were admitted to the ICU < 24 hours, and not expected to die <24 hours, were recruited. For the current study, we included patients with a BSI within +/- 3 days of ICU-admission, and matched controls without BSI in a 1:2 ratio. Diagnostic accuracy for BSI for the biomarkers on day 1, 2, and 3 of ICU admission was assessed. Sensitivity, specificity, negative and positive predictive values were calculated for pre-specified thresholds and for a data-driven cut off. Results In total 525 patients (n = 175 cases, 350 controls). The fixed low threshold for all 3 biomarkers (CRP = 20 mg/L, Leucocytes = 10 × 109/L, PCT = 0.4 ng/mL) resulted in negative predictive values on day 1: CRP: 0.91 (95% CI: 0.75 - 1.00), leukocyte: 0.75 (95% CI: 0.68 - 0.81), PCT: 0.91 (95% CI: 0.84 - 0.96). Combining the 3 biomarkers yielded similar results as PCT alone (p = 0.5). Conclusion CRP and PCT could in most cases rule out BSI in critically ill patients. Since almost no patients had low CRP and approximately 20% had low PCT, a low PCT could be used along with other information, to guide clinical decisions.

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Delayed treatment of bacteremia during the COVID-19 pandemic

et al. 2021

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ObjectivesCoronavirus disease (COVID-19) blindness, that is, the excessive consideration of the disease in diagnosis, has reportedly led to delayed diagnosis of some diseases. We compared several clinical measures between patients admitted for bacteremia during the two months of the COVID-19 pandemic and those admitted during the same period in 2019. We hypothesized that the pandemic has led to delayed treatment of bacteremia.MethodsThis retrospective observational study compared several measures undertaken for patients who visited the emergency unit in two hospitals between March 1 and May 31, 2020, during the COVID-19 pandemic and whose blood cultures tested positive for bacteremia with those for corresponding patients treated during the same period in 2019. The primary measure was time from consultation to blood culture/antimicrobials.ResultsWe included 29 eligible patients from 2020 and 26 from 2019. In 2020, the time from consultation to antimicrobial administration was significantly longer than in 2019 (mean [range], 222 [145–309] min vs. 139 [102–179] min, p=0.002). The frequency of chest computed tomography (CT) was significantly higher in 2020 (96.6 vs. 73.1%, p=0.021). Significant differences were not observed in the time to blood culture or chest CT preceding the blood culture between the two periods.ConclusionsOur findings suggested that due to the COVID-19 epidemic/pandemic, focusing on the exclusion of its infection using CT scans leads to an overall delay in the diagnosis and treatment of bacteremia. Medical providers must be aware of COVID-19 blindness and evaluate patients objectively based on rational criteria and take appropriate action.

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Predictors for delayed antibiotic administration among bacteraemic patients in the Emergency Department: Differences between medical and surgical interns

Cited by 3 publications

References 19 publications

Early source control of infection in patients seen in the emergency department: a systematic review

Early source control of infection in patients seen in the emergency department: a systematic review

Early Biomarker-Guided Prediction of Bloodstream Infection in Critically Ill Patients: C-Reactive Protein, Procalcitonin, and Leukocytes

Delayed treatment of bacteremia during the COVID-19 pandemic

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