Managing adult patients with infectious diseases in emergency departments: international ID-IRI study
Hakan Erdem, Sally Hargreaves, Handan Ankaralı, Hülya Çaşkurlu, Sevil Alkan, Asiye Bahar-Kacmaz, Meliha Meriç Koç, Mustafa Altındiş, Yasemin Yildiz-Kirazaldi, Filiz Kızılateş, Jameela Alsalman, Yasemin Çağ, Abu Hena Mostafa Kamal, İlyas Dökmetaş, Emine Kübra Dindar‐Demiray, Ghaydaa A. Shehata, Hakan Hasman, Ainur Sadykova, Ferrán Llopis, Ergys Ramosaço, Mateja Logar, Handan Alay, Fatma Kesmez-Can, Yvon Ruch, Dilek Bulut, Mateja Janković Makek, Andrea Marıno, Amjad Mahboob, Amani El‐Kholy, Dirar Abdallah, Merve Sefa-Sayar, Rıdvan Karaali, Selda Aslan, Razi Even Dar, Esam Abdalla, Helena Monzón-Camps, Rusmir Baljić, Dumitru Irina Mgdalena, Behrouz Naghili, Mohamed Dafalla, Ameen S. S. Alwashmi, Cernat Roxana Carmen, S Ramirez, Marzena Wojewódzka‐Żeleźniakowicz, Özay Akyıldız, Joanna Zajkowska, Rehab El-Sokkary, Nirav Pandya, Fatma Amer, Ilad Alavi Darazam, Svjetlana Grgić, Ahmed Ashraf Wegdan, Jehan El-Kholy, Cansu Bulut-Avsar, Sholpan Kulzhanova, Meltem Taşbakan, Hema Prakash Kumari, Natalia Dirani, Kalyan Koganti, Aidos Konkayev, Michael M. Petrov, Antonio Cascio, Anna Líšková, Rosa Fontana Del Vecchio, Lorenza Lambertenghi, Nikolay Mladenov, Serkan Öncü, Jordi Rello
Abstract
We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.