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)

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.