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Medical devices and multidrug-resistant infections in emergency department patients with sepsis: A prospective
Sonia Zotti1, Silvia Navarin1, Giacomo Casavecchia1
1Fondazione Policlinico Universitario Campus Bio-Medico, Department of Emergency Medicine, Rome, Italy.
Introduction:
The growing prevalence of patients carrying indwelling medical devices represents a challenge in the management of sepsis in the emergency department (ED). These patients may be at higher risk of infections caused by multidrug-resistant organisms (MDRO), potentially affecting antimicrobial management and outcomes. This study evaluated whether the presence of medical devices is associated with increased MDRO infections and adverse clinical outcomes in ED patients with sepsis.
Methods:
This prospective observational study included adult patients presenting with sepsis to the ED. Patients were classified as patients with devices (PwD) or naïve. Clinical characteristics, microbiological findings, antimicrobial therapy, and outcomes were recorded. Multivariable logistic regression models identified predictors of MDRO isolation and in-hospital mortality. Linear regression models, after logarithmic transformation, assessed predictors of hospital length of stay (LOS) and antibiotic therapy duration.
Results:
A total of 244 patients were included (122 PwD and 122 naïve), with MDRO identified in 32.4% of cases. Presence of medical devices was independently associated with MDRO isolation (OR 2.33, 95% CI 1.28-4.33; p = 0.006), together with septic shock (OR 3.53, 95% CI 1.81-6.98; p < 0.001). Conversely, it was not independently associated with in-hospital mortality (OR 1.19, 95% CI 0.55-2.58; p = 0.658). Increasing age (OR 1.04, 95% CI 1.01-1.08; p = 0.027) and septic shock (OR 15.83, 95% CI 7.42-35.59; p < 0.001) were the main predictors of mortality. MDRO isolation was independently associated with longer hospital length of stay (ratio 1.24, p = 0.016) and prolonged antibiotic therapy duration (ratio 1.28, p = 0.008).
Conclusions:
In ED patients with sepsis, the presence of medical devices is associated with increased MDRO infections but not with higher in-hospital mortality. MDRO contributes to increased healthcare utilization through longer hospitalization and prolonged antibiotic therapy.
Insights
Patients with medical devices in the emergency department (ED) with sepsis have a higher risk of multidrug-resistant organism (MDRO) infections. However, device presence was not linked to increased mortality, though MDROs led to longer hospital stays and antibiotic use.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- The increasing use of indwelling medical devices presents challenges in managing sepsis, particularly concerning multidrug-resistant organism (MDRO) infections.
- Patients with medical devices may face higher risks of MDRO infections, impacting treatment strategies and patient outcomes in the emergency department (ED).
Purpose of the Study:
- To evaluate the association between the presence of medical devices and the incidence of MDRO infections in ED patients with sepsis.
- To determine if medical devices are linked to adverse clinical outcomes, including in-hospital mortality, in this patient population.
Main Methods:
- A prospective observational study involving adult sepsis patients in the ED, categorized into those with devices (PwD) and device-naïve patients.
- Data collection included clinical characteristics, microbiological findings, antimicrobial therapy, and patient outcomes.
- Multivariable logistic and linear regression models were employed to identify predictors of MDRO isolation, mortality, hospital length of stay (LOS), and antibiotic duration.
Main Results:
- The study included 244 patients (122 PwD, 122 naïve), with MDROs found in 32.4% of cases.
- Medical device presence was independently associated with higher rates of MDRO isolation (OR 2.33) and septic shock (OR 3.53).
- Device presence was not independently associated with in-hospital mortality (OR 1.19), while increasing age and septic shock were key mortality predictors. MDRO isolation correlated with longer LOS and antibiotic therapy.
Conclusions:
- In ED sepsis patients, medical devices are linked to increased MDRO infections but not to higher in-hospital mortality.
- MDRO infections contribute significantly to increased healthcare utilization, evidenced by longer hospitalizations and prolonged antibiotic treatments.
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