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Observational Study
. 2025 Mar;20(2):573-583.
doi: 10.1007/s11739-024-03692-7. Epub 2024 Jul 13.

Bloodstream infections due to multi-drug resistant bacteria in the emergency department: prevalence, risk factors and outcomes-a retrospective observational study

Nicolò Capsoni  1   2 , Giulia Maria Azin  3 , Marida Scarnera  4 , Marco Bettina  4 , Riccardo Breviario  4 , Laura Ferrari  3 , Camilla Ferrari  5 , Daniele Privitera  3 , Chiara Vismara  6 , Alessandra Bielli  6 , Filippo Galbiati  3 , Davide Paolo Bernasconi  4   7 , Marco Merli  8 , Michele Bombelli  4   9
Affiliations
Observational Study

Bloodstream infections due to multi-drug resistant bacteria in the emergency department: prevalence, risk factors and outcomes-a retrospective observational study

Nicolò Capsoni et al. Intern Emerg Med. 2025 Mar.

Abstract

Multidrug-resistant organisms (MDROs) are prevalent in patients admitted to the Emergency Department (ED) and increase the risk of inappropriate empirical antibiotic therapy. Risk stratification for MDRO infection is essential to early identify patients requiring empirical broad-spectrum antibiotic therapy, but it remains challenging for emergency physicians. This study aimed to evaluate prevalence, risk factors, and outcomes of patients admitted to the ED with a bloodstream infection (BSI) caused by MDROs. A retrospective observational study enrolling all consecutive adult patients admitted with a BSI to the ED of Niguarda Hospital, Italy, from January 2019 to December 2021 was performed. 757 patients were enrolled, 14.1% with septic shock. 156 (20%) patients had a BSI caused by MDRO: extended-spectrum beta-lactamase (ESBL) producing Enterobacterales were the most prevalent followed by methicillin-resistant Staphylococcus aureus (MRSA). Risk factors for BSI due to MDRO and specifically for ESBL were chronic renal failure (OR 2.2; 95%CI 1.4-3.6), nursing home residency (OR 4.4; 95%CI 1.9-10.2) and antibiotic therapy in the last 90-days (OR 2.6; 95%CI 1.7-4), whereas for MRSA were dialysis (OR 12.3; 95%CI 1.8-83), antibiotic therapy and/or hospital admission in the past 90-days (OR 3.6; 95%CI 1.2-10.6) and ureteral stent or nephrostomy (OR 7.8; 95%CI 1.5-40.9). Patients with BSI due to MDRO had a higher rate of inappropriate empirical antibiotic therapy (50%) and longer length of stay, but no higher in-hospital mortality. Among patients admitted to the ED with a BSI, MDROs are frequent and often associated with inappropriate empirical antibiotic therapy. Specific updated risk factors for MDRO may help clinicians to better identify patients requiring a broader antibiotic therapy in the ED, while awaiting microbiological results.

Keywords: Enterobacteriaceae; Anti-bacterial agents; Beta-lactamases; MRSA; Sepsis; Septic shock.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict interest. Statement of human and animal rights: The study was approved by the local ethical committee of Milano Area 3 (ethical approval number 338-18052022). Informed consent: Owing to retrospective and de-identified data collection, the need for informed consent was waived.

Figures

Fig. 1
Fig. 1
Flow diagram of the study population. ED emergency department
Fig. 2
Fig. 2
MDRO prevalence, antibiotic inappropriateness, septic shock and in-hospital mortality according to site of infection. Numbers refers to percentages. MDRO multi-drug resistant organism, ATB antibiotic
See this image and copyright information in PMC

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