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Epidemiology of infections treated in hospital emergency departments and changes since 12 years earlier: the INFURG study of the Spanish Society of Emergency Medicine (SEMES)




Martínez Ortiz de Zárate M, González Del Castillo J, Julián Jiménez A, Piñera Salmerón P, Llopis Roca F, Guardiola Tey JM, Chanovas Borràs M, Ruiz Grinspan M, García Lamberechts EJ, Ibero Esparza C, Moya Mir MS , González Martínez F, Candel González FJ



Servicio de Urgencias, Hospital Universitario de Basurto, Bilbao, Spain. Servicio de Urgencias, Hospital ClĂ­nico San Carlos, Madrid, Spain. Servicio de Urgencias, Hospital Virgen de la Salud, Toledo, Spain. Servicio de Urgencias, Hospital Reina SofĂ­a, Murcia, Spain. Servicio de Urgencias, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Servicio de Urgencias, Hospital de Tortosa Verge de la Cinta, IISPU, Tortosa, Tarragona, Spain. Servicio de Urgencias, Hospital de Henares, Coslada, Madrid, Spain. Servicio de Urgencias, Hospital GarcĂ­a Orcoyen, Estella, Navarra, Spain. Servicio de Urgencias, Hospital Puerta de Hierro, Madrid, Spain. Servicio de Urgencias, Hospital Virgen de la Luz, Cuenca, Spain. Servicio de MicrobiologĂ­a ClĂ­nica, Hospital ClĂ­nico San Carlos, Madrid, Spain.



Objectives: To estimate the prevalence of infectious disease treated in Spanish hospital
emergency departments and to describe the characteristics and management of patients
with infections and their clinical course in comparison with a cohort studied 12 years
earlier.
Methods: Multicenter descriptive, cross-sectional study of 49 Spanish emergency
departments on the 10th and 20th day of each of 12 months. To estimate prevalence
we registered cases in which the diagnosis was infection, noting the location of infection
and the total number of times the patient was attended during the study period. To
describe patient characteristics and management, we recorded demographic data,
concomitant diseases, risk factors for multidrug resistant infection, microbiologic tests
ordered, antibiotic treatments prescribed, destination on discharge, and mortality before
discharge.
Results: The prevalence of infectious diseases in the participating emergency
departments was 14.3% (4.6%, respiratory tract; 3.2% urinary tract; 2.1%, ear-nosethroat;
1.6%, skin and soft-tissues; and 2.8% other). Infections related to diabetes
mellitus, heart disease, or chronic obstructive pulmonary disease accounted for 4543
(39.8%) of the total, and 707 (6.2%) patients had sepsis on arrival. Microbiology was
not ordered in 6463 cases (56.7%), and amoxicillin-clavulanic acid was the most
frequently prescribed antibiotic, used in 3600 cases (31.6%). A total of 1022 patients
(9%) were already taking antibiotics when they came to the emergency department.
Forty-six patients (0.5%) died before discharge from the department and 2653 (23.3%)
were hospitalized.
Conclusions: Patients with infections, especially involving the respiratory or urinary
tracts, account for a large proportion of the Spanish hospital emergency department
caseloads studied. We observed an increase in the prevalence of infection in comparison
with the study 12 years earlier. Patients in the recent study were older, were more often
septic, and had more concomitant diseases and more risk factors for multidrug resistant
infections.


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