Incidence of Multidrug Resistant Infections in Emergency Department Patients with Suspected Sepsis
Copyright © 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Inappropriate antibiotic therapy in sepsis is associated with poor outcomes, clinicians often provide routine coverage for multidrug resistant (MDR) bacteria. However, these regimens may contribute to problems related to antibiotic overuse. To understand the incidence and related factors of multidrug resistant bacterial infections in ED patients with sepsis, we examined how often patients with sepsis in our emergency department had MDR infections. We also explored risk factors for, and outcomes from, MDR bacterial infections.
METHODS: We reviewed records of patients presenting to our emergency department (ED) meeting criteria for severe sepsis or septic shock from March 2012 to July 2013. Patient demographics, comorbidities, preadmission location, and APACHE II scores were analyzed, as were clinical outcomes.
RESULTS: A total of 191 episodes were examined. 108 (57%) cases were culture-positive, and of these, 23 (12.0%) had an MDR pathogen recovered. Among patients with positive cultures, MDR patients used mechanical ventilation more often 29% vs. 52% (P = 0.03) and had longer mean ICU and hospital length of stays: 4.0 vs 9.3 (P < 0.08) and 10.6 vs 20.8 (P = 0.01), respectively. We did not identify statistically significant predictors of MDR infection.
CONCLUSIONS: The overall number of infections due to MDR bacteria was low, and MDR gram-negative infections were uncommon. The use of multiple empiric antibiotics for resistant gram-negative infections in the ED may be beneficial in only a small number of cases. Additionally, empiric coverage for vancomycin-resistant enterococci may need to be considered more often. Larger studies may help further elucidate the rates of MDR infections in ED patients, and identify specific risk factors to rationally guide empiric antibiotic treatment.
| Errataetall: |
CommentIn: Am J Med Sci. 2020 Dec;360(6):613-614. - PMID 32980122 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:360 |
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| Enthalten in: |
The American journal of the medical sciences - 360(2020), 6 vom: 24. Dez., Seite 650-655 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Oxman, David [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-Bacterial Agents |
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| Anmerkungen: |
Date Completed 29.12.2020 Date Revised 29.12.2020 published: Print-Electronic CommentIn: Am J Med Sci. 2020 Dec;360(6):613-614. - PMID 32980122 Citation Status MEDLINE |
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| doi: |
10.1016/j.amjms.2020.07.019 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM314411372 |
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| 500 | |a Date Revised 29.12.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Am J Med Sci. 2020 Dec;360(6):613-614. - PMID 32980122 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Inappropriate antibiotic therapy in sepsis is associated with poor outcomes, clinicians often provide routine coverage for multidrug resistant (MDR) bacteria. However, these regimens may contribute to problems related to antibiotic overuse. To understand the incidence and related factors of multidrug resistant bacterial infections in ED patients with sepsis, we examined how often patients with sepsis in our emergency department had MDR infections. We also explored risk factors for, and outcomes from, MDR bacterial infections | ||
| 520 | |a METHODS: We reviewed records of patients presenting to our emergency department (ED) meeting criteria for severe sepsis or septic shock from March 2012 to July 2013. Patient demographics, comorbidities, preadmission location, and APACHE II scores were analyzed, as were clinical outcomes | ||
| 520 | |a RESULTS: A total of 191 episodes were examined. 108 (57%) cases were culture-positive, and of these, 23 (12.0%) had an MDR pathogen recovered. Among patients with positive cultures, MDR patients used mechanical ventilation more often 29% vs. 52% (P = 0.03) and had longer mean ICU and hospital length of stays: 4.0 vs 9.3 (P < 0.08) and 10.6 vs 20.8 (P = 0.01), respectively. We did not identify statistically significant predictors of MDR infection | ||
| 520 | |a CONCLUSIONS: The overall number of infections due to MDR bacteria was low, and MDR gram-negative infections were uncommon. The use of multiple empiric antibiotics for resistant gram-negative infections in the ED may be beneficial in only a small number of cases. Additionally, empiric coverage for vancomycin-resistant enterococci may need to be considered more often. Larger studies may help further elucidate the rates of MDR infections in ED patients, and identify specific risk factors to rationally guide empiric antibiotic treatment | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antibiotic management | |
| 650 | 4 | |a Drug resistance | |
| 650 | 4 | |a Sepsis | |
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| 700 | 1 | |a Lohr, Kristin |e verfasserin |4 aut | |
| 700 | 1 | |a Gupta, Ena |e verfasserin |4 aut | |
| 700 | 1 | |a Madara, John |e verfasserin |4 aut | |
| 700 | 1 | |a Len, Edward |e verfasserin |4 aut | |
| 700 | 1 | |a Hseih, Jerry |e verfasserin |4 aut | |
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