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

Erdem, Hakan; Hargreaves, Sally; Ankaralı, Handan; Çaşkurlu, Hülya; Çevıker, Sevil Alkan; Bahar-Kacmaz, Asiye; Meriç-Koç, Meliha; Altındiş, Mustafa; Yildiz-Kirazaldi, Yasemin; Kızılateş, Filiz; Al-Salman, Jameela; Çağ, Yasemin; Kamal, Abu Hena Mostafa; Dökmetaş, İlyas; Dindar-Demiray, Emine Kubra; Shehata, Ghaydaa A.; Hasman, Hakan; Sadykova, Ainur; Llopis, Ferrán; Ramosaço, Ergys; Logar, Mateja; Alay, Handan; Kesmez-Can, Fatma; Ruch, Yvon; Bulut, Dilek; Makek, Mateja Janković; Marino, Andrea; Mahboob, Amjad; El-Kholy, Amani; Abdallah, Dirar; Sefa-Sayar, Merve; Karaali, Rıdvan; Aslan, Selda; Dar, Razi Even; Abdalla, E. M.; Monzón-Camps, Helena; Baljić, Rusmir; Mgdalena, Dumitru Irina; Naghili, Behrooz; Dafalla, Mohamed; Alwashmi, Ameen S. S.; Carmen, Cernat Roxana; Ramirez-Estrada, Sergio; Wojewódzka-Żelezniakowicz, Marzena; Akyildiz, Özay; Zajkowska, Joanna; El-Sokkary, Rehab H.; Pandya, Nirav; Amer, Fatma; Alavi-Darazam, Ilad; Grgić, Svjetlana; Wegdan, Ahmed Ashraf; El-Kholy, Jehan; Bulut-Avsar, Cansu; Kulzhanova, Sholpan; Taşbakan, Meltem; Kumari, Hema Prakash; Dirani, Natalia; Koganti, Kalyan; Konkayev, Aidos; Petrov, Michael M.; Cascio, Antonio; Líšková, Anna; Vecchio, Rosa Fontana Del; Lambertenghi, Lorenza; Mladenov, Nikolay; Öncü, Serkan; Rello, Jordi

doi:10.1080/1120009x.2020.1863696

Cited by 24 publications

(17 citation statements)

References 22 publications

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“…The difference in microorganisms and resistance patterns for infections acquired in the community compared with hospital settings may deliver data for national, healthcare facility, and community AS programs [13]. Patients with communityacquired infections taken directly from the emergency departments to the ICUs are a nonnegligible group [14]. In this report, the rate of community-acquired infections was 30.4%, highlighting the need to support the prevention efforts in community settings.…”

Section: Discussionmentioning

confidence: 81%

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Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey

El-Sokkary

Uysal²,

Erdem³

et al. 2021

Eur J Clin Microbiol Infect Dis

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Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI,) and the hospitalacquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI,) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.

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Section: Discussionmentioning

confidence: 81%

“…Different economic levels were represented: lower-middle-income (LMI (n = 13), upper-middleincome (UMI) (n = 33), and high-income (HI) countries (n = 11), as per the World Bank [8]. The participating ICUs were medical (16), surgical (14), medical-surgical (20), and neonatal and pediatric units (7).…”

Section: Study Settingsmentioning

confidence: 99%

Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey

El-Sokkary

Uysal²,

Erdem³

et al. 2021

Eur J Clin Microbiol Infect Dis

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“…In a study published by Montrucchio et al, the presence of a carbapenemase-producing coinfection with Klebsiella pneumoniae was correlated with the presence of comorbidities such as hypertension, asthma, smoking and obesity and the administration of corticosteroids and tocilizumab, as well as a previous administration of broad-spectrum antibiotics [ 17 ]. International studies have shown that antibiotics such as ceftriaxone, doxycycline, azithromycin, quinolones and carbapenems have been widely used for COVID-19 infections, even in the absence of obvious signs of bacterial infections [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-Resistant Klebsiella pneumoniae Associated with COVID-19

Dumitru

Dumitrașcu²,

Vlad

et al. 2021

Antibiotics

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Infections with carbapenem-resistant Enterobacteriaceae are emerging as an important challenge in healthcare settings. Currently, carbapenem-resistant Klebsiella pneumoniae (CRKP) are the species of CRE most commonly encountered in hospitals. CRKP is resistant to almost all available antimicrobial agents, and infections with CRKP have been associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization exposed to invasive devices. We report nine patients hospitalized in an intensive care unit (ICU) with severe coronavirus disease 2019 (COVID-19) who developed invasive infections due to carbapenemase-producing Klebsiella pneumoniae (CP-Kp), KPC and OXA-48, strains that have not been previously identified in our hospital. Despite ceftazidime/avibactam therapy, five patients died. Coinfections can contribute to a poor prognosis for patients with COVID-19, especially for high-risk populations such as elderly patients. Therefore, it is crucial to establish a rigorous program of antibiotic administration in intensive care units.

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“…As suggested by guidelines and literature evidence (19,20), an analgesic cocktail was administered, along with RBC exchange to achieve prompt pain control. Moreover, due to the presence of fever along with increased CRP and procalcitonin levels, antibiotic therapy was administered, and cultural tests were performed to rule out and treat bacterial superinfections, whereas viral coinfections, including HIV, HBV and HCV, were already excluded according to protocols (21)(22)(23)(24)(25)(26)(27). Previous research has highlighted the risk of delaying appropriate management during VOCs in patients with SCD (12).…”

Section: Discussionmentioning

confidence: 99%

Pain crisis management in a patient with sickle cell disease during SARS‑CoV‑2 infection: A case report and literature review

et al. 2022

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Patients with sickle cell disease (SCD) are more susceptible to severe coronavirus disease 2019 (COVID-19) infection, in comparison with the general population, due to the possibility that the inflammatory state, along with hypoxia and hypercoagulability may increase the risk of developing acute SCD-related complications. The present study reports the case of a 33-year-old female affected by SCD, who although vaccinated against COVID-19, tested positive for SARS-CoV-2 and developed febrile pneumonia. During hospitalization, the patient complained about generalized intense pain, along with fever recurrence and increased inflammatory marker, procalcitonin and haemoglobin S levels. The patient was treated with an intravenous analgesic therapeutics cocktail in combination with red blood cell manual exchange procedure and broad-spectrum antibiotic therapy, achieving the rapid resolution of pain and an improvement in the laboratory test results. From the case presented herein, it is thus suggested that patients with SCD and COVID-19 infection need to be critically evaluated by clinicians, as such patients may develop severe outcomes, attributed to the overlap of two difficult to treat conditions.

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

Cited by 24 publications

References 22 publications

Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey

Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey

Carbapenem-Resistant Klebsiella pneumoniae Associated with COVID-19

Pain crisis management in a patient with sickle cell disease during SARS‑CoV‑2 infection: A case report and literature review

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