Bloodstream infections due to multi-drug resistant bacteria in the emergency department: prevalence, risk factors and outcomes—a retrospective observational study

Capsoni, Nicolò; Azin, Giulia Maria; Scarnera, Marida; Bettina, Marco; Breviario, Riccardo; Ferrari, Laura; Ferrari, Camilla; PRIVITERA, Daniele; Vismara, Chiara; Bielli, Alessandra; Galbiati, Filippo; Bernasconi, Davide Paolo; Merli, Marco; Bombelli, Michele

doi:10.1007/s11739-024-03692-7

Article (Scientific journals)

Bloodstream infections due to multi-drug resistant bacteria in the emergency department: prevalence, risk factors and outcomes—a retrospective observational study

Capsoni, Nicolò; Azin, Giulia Maria; Scarnera, Marida et al.

2025 • In Internal and Emergency Medicine, 20 (2), p. 573 - 583

Peer Reviewed verified by ORBi

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https://hdl.handle.net/10993/66512

DOI
10.1007/s11739-024-03692-7

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39001978

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Keywords :

Anti-bacterial agents; Beta-lactamases; Enterobacteriaceae; MRSA; Sepsis; Septic shock; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Drug Resistance, Multiple, Bacterial; Emergency Service, Hospital; Female; Humans; Italy; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; antiinfective agent; adult; aged; bacteremia; drug effect; drug therapy; epidemiology; female; hospital emergency service; human; male; methicillin resistant Staphylococcus aureus; microbiology; middle aged; multidrug resistance; organization and management; prevalence; retrospective study; risk factor; very elderly

Abstract :

[en] Multidrug-resistant organisms (MDROs) are prevalent in patients admitted to the Emergency Department (ED) and increase the risk of inappropriate empirical antibiotic therapy. Risk stratification for MDRO infection is essential to early identify patients requiring empirical broad-spectrum antibiotic therapy, but it remains challenging for emergency physicians. This study aimed to evaluate prevalence, risk factors, and outcomes of patients admitted to the ED with a bloodstream infection (BSI) caused by MDROs. A retrospective observational study enrolling all consecutive adult patients admitted with a BSI to the ED of Niguarda Hospital, Italy, from January 2019 to December 2021 was performed. 757 patients were enrolled, 14.1% with septic shock. 156 (20%) patients had a BSI caused by MDRO: extended-spectrum beta-lactamase (ESBL) producing Enterobacterales were the most prevalent followed by methicillin-resistant Staphylococcus aureus (MRSA). Risk factors for BSI due to MDRO and specifically for ESBL were chronic renal failure (OR 2.2; 95%CI 1.4–3.6), nursing home residency (OR 4.4; 95%CI 1.9–10.2) and antibiotic therapy in the last 90–days (OR 2.6; 95%CI 1.7–4), whereas for MRSA were dialysis (OR 12.3; 95%CI 1.8–83), antibiotic therapy and/or hospital admission in the past 90-days (OR 3.6; 95%CI 1.2–10.6) and ureteral stent or nephrostomy (OR 7.8; 95%CI 1.5–40.9). Patients with BSI due to MDRO had a higher rate of inappropriate empirical antibiotic therapy (50%) and longer length of stay, but no higher in-hospital mortality. Among patients admitted to the ED with a BSI, MDROs are frequent and often associated with inappropriate empirical antibiotic therapy. Specific updated risk factors for MDRO may help clinicians to better identify patients requiring a broader antibiotic therapy in the ED, while awaiting microbiological results. © The Author(s) 2024.

Disciplines :

General & internal medicine

Author, co-author :

Capsoni, Nicolò; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy ; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Azin, Giulia Maria; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Scarnera, Marida; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

Bettina, Marco; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

Breviario, Riccardo; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

Ferrari, Laura; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Ferrari, Camilla; Department of Medicine and Surgery, University of Milan, Milan, Italy

PRIVITERA, Daniele ; University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Life Sciences and Medicine (DLSM) > Medical Education ; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Vismara, Chiara; Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Bielli, Alessandra; Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

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Language :

English

Title :

Bloodstream infections due to multi-drug resistant bacteria in the emergency department: prevalence, risk factors and outcomes—a retrospective observational study

Publication date :

2025

Journal title :

Internal and Emergency Medicine

ISSN :

1828-0447

Publisher :

Springer Science and Business Media Deutschland GmbH

Volume :

Issue :

Pages :

573 - 583

Peer reviewed :

Peer Reviewed verified by ORBi

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