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Antimicrobial stewardship at the emergency department: Dead bugs do not mutate!

  • Jordi Rello
    Correspondence
    Corresponding author at: Hospital Vall d'Hebron. Ps Vall d'Hebron 129. AMI-14, 08035 Barcelona, Spain
    Affiliations
    Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Research Institute, Barcelona, Spain

    Recherche in Pôle Reánimation, Urgences et Douleur, CHU Nîmes, Nîmes, France
    Search for articles by this author
  • José Artur Paiva
    Affiliations
    Intensive Care Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal

    Medicine Departement, Faculty of Medicine, University of Porto, Portugal
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Published:January 19, 2023DOI:https://doi.org/10.1016/j.ejim.2023.01.014
      Detecting organisms in blood is a key determinant in sepsis management [
      • Rello J.
      • van Engelen T.S.R.
      • Alp E.
      • Calandra T.
      • Cattoir V.
      • Kern W.V.
      • et al.
      Towards precision medicine in sepsis: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.
      ] and in optimizing antimicrobial use in hospitalized patients [
      • Vieceli T.
      • Rello J.
      Optimization of antibiotic therapy at the hospital.
      ]. Conway et al. [
      • Conway R.
      • Byrne D.G.
      • O'Riordan D.
      • Silke B.
      European Journal Intern Med Prognostic value of positive blood cultures and culture results on outcomes in emergency medical admissions.
      ] reported that blood cultures were performed in around one out of five adults admitted to an internal medicine ward from the Emergency Department (ED) and almost one out of five of these blood cultures were positive. Globally, 4.2% of the patients admitted to the Internal Medicine ward had positive blood cultures taken at the ED and these patients had worse outcomes, namely 30-day mortality and hospital length of stay. Severity-of-illness at admission and comorbidities were major outcomes’ determinants whereas the specific identified organism had limited impact.

      Keywords

      Abbreviations:

      ED (Emergency Department), AMS (antimicrobial stewardhip), ECMO (extracorporeal membrane oxygenation)
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