Sepsis 3-hour bundle compliance and prognosis in emergency department patients aged 65 years or older. / Cumplimiento del paquete de medidas en las primeras tres horas en urgencias y su relación con el pronóstico de los pacientes mayores de 65 años con sepsis.

OBJECTIVES: To analyze 3-hour bundle compliance in for patients aged 65 years or older with sepsis treated in our emergency department (ED) and to explore the association between compliance and mortality. MATERIAL AND METHODS: Retrospective observational study in patients aged 65 years or older treated in our ED between January 1, 2020 and December 31, 2022. Factors associated with mortality at the end of the episode were also analyzed. RESULTS: Data for 190 patients were analyzed; 98 (51%) were men. Eighty-five (45%) were aged between 65 and 79 years, and 105 (55%) were aged 80 years or older. Mortality was higher in the patients over 80 years of age (62%) vs 33% of the patients under 80 years of age (P = .001). Overall mean survival time was 38 days (95% CI, 28-48 days). Cox regression analysis showed that 3-hour bundle compliance was associated with longer survival (HR, 0.56; 95% CI, 0.34-0.95; P = .03). Mean survival in patients older than 80 years was 21 days (95% CI, 13-30 days), and 3-hour bundle compliance was associated with longer survival (hazard ratio, 0.51; 95% CI, 0.3-0.9; P = .02). CONCLUSION: Three-hour sepsis bundle compliance in the ED was associated with longer survival in patients aged 65 years or older.

OBJETIVO: Analizar el cumplimiento del paquete de medidas de tratamiento de la sepsis en las primeras 3 horas de asistencia en urgencias y su relación con la mortalidad en una cohorte de pacientes $ 65 años. METODO: Estudio observacional retrospectivo. Se seleccionaron los pacientes con una edad $ 65 años visitados en urgencias del 1 de enero de 2020 al 31 de diciembre de 2022 diagnosticados de sepsis o shock séptico. Se determinaron los factores asociados a mortalidad al final del episodio. RESULTADOS: Se incluyeron 190 pacientes, 98 (51%) varones y 85 (45%) tenían una edad 65­79 años (añosos) y 105 (55%) $ 80 años (muy añosos). La mortalidad al final del episodio fue mayor en el grupo de pacientes muy añosos (62% vs 33%, p = 0,001). La media de supervivencia fue de 38 días (IC 95%: 28-48). Mediante regresión de Cox se determinó que el cumplimiento del paquete de medidas en las primeras tres horas se asoció a mayor supervivencia (HR: 0,56, IC 95%: 0,34-0,95 p = 0,03). En el grupo de pacientes muy añosos, la media de supervivencia fue de 21 días (IC 95%: 1-30); el cumplimiento de las medidas dentro de las primeras 3 horas se asoció a mayor supervivencia (HR: 0,51, IC 95%: 0,3-0,9 p = 0,02). CONCLUSIONES: El cumplimiento del paquete de medidas en las primeras 3 horas se asoció con una mayor supervivencia en los pacientes mayores de 65 años con sepsis en urgencias.

A bacteraemia risk prediction model: development and validation in an emergency medicine population.

OBJECTIVE: Design a risk model to predict bacteraemia in patients attended in emergency departments (ED) for an episode of infection. METHODS: This was a national, prospective, multicentre, observational cohort study of blood cultures (BC) collected from adult patients (≥ 18 years) attended in 71 Spanish EDs from October 1 2019 to March 31, 2020. Variables with a p value < 0.05 were introduced in the univariate analysis together with those of clinical significance. The final selection of variables for the scoring scale was made by logistic regression with selection by introduction. The results obtained were internally validated by dividing the sample in a derivation and a validation cohort. RESULTS: A total of 4,439 infectious episodes were included. Of these, 899 (20.25%) were considered as true bacteraemia. A predictive model for bacteraemia was defined with seven variables according to the Bacteraemia Prediction Model of the INFURG-SEMES group (MPB-INFURG-SEMES). The model achieved an area under the curve-receiver operating curve of 0.924 (CI 95%:0.914-0.934) in the derivation cohort, and 0.926 (CI 95%: 0.910-0.942) in the validation cohort. Patients were then split into ten risk categories, and had the following rates of risk: 0.2%(0 points), 0.4%(1 point), 0.9%(2 points), 1.8%(3 points), 4.7%(4 points), 19.1% (5 points), 39.1% (6 points), 56.8% (7 points), 71.1% (8 points), 82.7% (9 points) and 90.1% (10 points). Findings were similar in the validation cohort. The cut-off point of five points provided the best precision with a sensitivity of 95.94%, specificity of 76.28%, positive predictive value of 53.63% and negative predictive value of 98.50%. CONCLUSION: The MPB-INFURG-SEMES model may be useful for the stratification of risk of bacteraemia in adult patients with infection in EDs, together with clinical judgement and other variables independent of the process and the patient.

Validation of a predictive model for bacteraemia (MPB5-Toledo) in the patients seen in emergency departments due to infections. / Validación del modelo predictivo de bacteriemia (5MPB-Toledo) en los pacientes atendidos en el servicio de urgencias por infección.

OBJECTIVE: To validate a simple risk score to predict bacteremia (MPB5-Toledo) in patients seen in the emergency departments (ED) due to infections. METHODS: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered in 74 Spanish ED for adults (aged 18 or older) seen from from October 1, 2019, to February 29, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the cut-off values chosen for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: A total of 3.843 blood samples wered cultured. True cases of bacteremia were confirmed in 839 (21.83%). The remaining 3.004 cultures (78.17%) were negative. Among the negative, 172 (4.47%) were judged to be contaminated. Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.5%, 16.8%, and 81.6%, respectively. The model's area under the receiver operating characteristic curve was 0.930 (95% CI, 0.916-0.948). The prognostic performance with a model's cut-off value of ≥ 5 points achieved 94.76% (95% CI: 92.97-96.12) sensitivity, 81.56% (95% CI: 80.11-82.92) specificity, and negative predictive value of 98.24% (95% CI: 97.62-98.70). CONCLUSION: The 5MPB-Toledo score is useful for predicting bacteremia in patients attended in hospital emergency departments for infection.

A multidrug-resistant microorganism infection risk prediction model: development and validation in an emergency medicine population.

The aim was to develop a predictive model of infection by multidrug-resistant microorganisms (MDRO). A national, retrospective cohort study was carried out including all patients attended for an infectious disease in 54 Spanish Emergency Departments (ED), in whom a microbiological isolation was available from a culture obtained during their attention in the ED. A MDRO infection prediction model was created in a derivation cohort using backward logistic regression. Those variables significant at p < 0.05 assigned an integer score proportional to the regression coefficient. The model was then internally validated by k-fold cross-validation and in the validation cohort. A total of 5460 patients were included; 1345 (24.6%) were considered to have a MDRO infection. Twelve independent risk factors were identified in the derivation cohort and were combined into an overall score, the ATM (assessment of threat for MDRO) score. The model achieved an area under the curve-receiver operating curve of 0.76 (CI 95% 0.74-0.78) in the derivation cohort and 0.72 (CI 95% 0.70-0.75) in the validation cohort (p = 0.0584). Patients were then split into 6 risk categories and had the following rates of risk: 7% (0-2 points), 16% (3-5 points), 24% (6-9 points), 33% (10-14 points), 47% (15-21 points), and 71% (> 21 points). Findings were similar in the validation cohort. Several patient-specific factors were independently associated with MDRO infection risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were related to an increased risk for MDRO infection. This clinical prediction rule could be used by providers to identify patients at high risk and help to guide antibiotic strategy decisions, while accounting for clinical judgment.