Managing adult patients with infectious diseases in emergency departments: international ID-IRI study

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 (<b><i>P</i> < 0.001</b>). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (<i>n</i> = 877, 43.3%), lower-respiratory (<i>n</i> = 316, 16.1%), and lower-urinary (<i>n</i> = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (<i>n</i> = 307, 15.7%), third-generation cephalosporins (<i>n</i> = 251, 12.8%), and quinolones (<i>n</i> = 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.