Infection In Emergency Department Research Articles

Prevalence and demographics of methicillin resistant Staphylococcus aureusin culturable skin and soft tissue infections in an urban emergency department

BackgroundThe rising incidence of methicillin resistant Staph. aureus (MRSA) infections is a concern for emergency practitioners. While studies have examined MRSA in inpatients, few have focused on emergency department populations. We sought to describe predictors of MRSA skin infections in an emergency department population.MethodsThis was a prospective observational cohort study conducted over three months in 2005. A convenience sample of patients with culturable skin infections presenting to a busy, urban emergency department was enrolled. Demographic and risk factor information was collected by structured interview. The predictive value of each risk factor for MRSA, as identified by culture, was tested using univariable logistic regression, and a multivariable predictive model was developed.ResultsPatients were 43% black, 40% female and mean age was 39 years (SD 14 years). Of the 182 patients with cultures, prevalence of MRSA was 58% (95%CI 50% to 65%). Significant predictors of MRSA were youth, lower body mass index, sexual contact in the past month, presence of an abscess cavity, spontaneous infection, and incarceration. The multivariable model had a C-statistic of 0.73 (95%CI 0.67 to 0.79) with four significant variables: age, group living, abscess cavity, and sexual contact within one month.ConclusionIn this population of emergency department patients, MRSA skin infection was related to youth, recent sexual contact, presence of abscess, low body mass index, spontaneity of infection, incarceration or contact with an inmate, and group home living.

Risk factors for inappropriate ciprofloxacin use in an emergency department

Study objectives: Ciprofloxacin, one of the most widely used fluoroquinolones, has been prescribed for some abdominal and genitourinary infections in emergency departments (EDs). Recent studies reported the increasing tendency of the resistance to fluoroquinolones, which is associated with previous fluoroquinolone use. This study was performed to identify the risk factors of the inappropriate use of ciprofloxacin in the ED. Methods: We retrospectively reviewed medical records of patients who visited the ED of Seoul National University Hospital, Korea, and were prescribed ciprofloxacin as empirical initial antibiotics from January 2002 to December 2002. The appropriateness of ciprofloxacin use was judged according to the existing institutional guideline, mainly based on <i>The Sanford Guide to Antimicrobial Therapy (2003).</i> Results: Of the total 577 patients (219 men, mean age 53.0±17.1 years; 358 women, mean age 50.3±18.7 years), ciprofloxacin was used appropriately in 289 (50.1%) patients and inappropriately in 288 (49.9%) patients. In univariate analysis, distributions of age, sex, site of suspected infection, route of administration, and disposition were significantly different between the appropriate and inappropriate use groups (<i>P</i><.005). In multivariate analysis, the adjusted odds ratio (OR) for related factors on inappropriate ciprofloxacin use was significantly higher in the older-age (>65 years) group than in the younger-age group (<64 years; OR 2.188, 95% confidence interval [CI] 1.093 to 4.379) for patients who had gastrointestinal tract infection rather than genitourinary tract infection (OR 17.317, 95% CI 9.935 to 30.182) and for patients who were discharged from or stayed in the ED than for those who were admitted to the ward (OR 3.574, 95% CI 1.653 to 7.728). Conclusion: Inappropriate use of ciprofloxacin in the ED is a common problem. To limit the emergence of ciprofloxacin-resistant organisms, education and effort for judicious use of ciprofloxacin are warranted. This study has some limitations, such as not being blinded, being a single-institution study, and having an absence of consequence analysis. Further studies for evaluation of the clinical consequences of inappropriate use of ciprofloxacin are needed.

Diagnostic value of procalcitonin levels as an early indicator of sepsis

Researchers and clinicians have been investigating and implementing various methods of early diagnosis for sepsis before documentation of infection. The aim of this study was to outline the efficiency of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) in determining the early diagnosis of sepsis in the emergency department. Between January 1999 and September 2000, 34 patients with signs of systemic inflammatory response syndrome (SIRS) were enrolled in the study. The patients were divided into 2 groups according to nonsuspected sepsis and suspected sepsis clinically. Admission PCT was significantly higher in suspected sepsis group (median 68.7 μg/L; lower [L] = 15.24 μg/L, upper [U] = 120.54 μg/L) compared with the unsuspected sepsis group (.23 μg/L; L = .10 μg/L, U = .44 μg/L). PCT values were compared with WBC and CRP levels. Predictive accuracy for sepsis expressed as area under the receiver operating characteristic (ROC) curve was .88 for PCT, .44 for WBC, and .34 for CRP. PCT can probably be used as a predictive marker in bacterial infections in emergency departments. (Am J Emerg Med 2002;20:202-206. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Three common presentations of ascariasis infection in an urban Emergency Department

In the United States, approximately 4 million people per year are infected with Ascaris lumbricoides. We reviewed the common presentations of complications of Ascariasis infection in the Emergency Department (ED) and the diagnostic tools and treatment available. This was a retrospective case review conducted on all patients diagnosed with Ascariasis (using ICD-9 codes) over a 6-year period at Los Angeles County and University of Southern California Medical Center. Three patients with distinct complications secondary to Ascariasis were chosen, and all ED and inpatient records were reviewed. The patient’s age, sex, race, presenting symptoms, data, outcome, and ED course and diagnosis were recorded. The three cases included a periappendiceal abscess, Loeffler’s syndrome, and biliary colic/choledocholithiasis. The first patient underwent a computed tomography-guided drainage of the abscess. The second patient received supportive care and antibiotic therapy secondary to a superimposed bacterial pneumonia. The third patient underwent endoscopic retrograde cholangiopancreatography with sphincterotomy. All three patients had a stool ova and parasites positive for A. lumbricoides, and all received a 3-day course of mebendazole. Symptomatic cases of Ascariasis may present to EDs in the United States. Important diagnostic tools for the ED include chest X-ray, X-ray of the kidney-ureter-bladder and ultrasonography. Single-dose medications given in the ED are very effective in eradicating A. lumbricoides infection, thus avoiding hospitalization.

Antibiotic prescribing for patients with colds, upper respiratory tract infections, and bronchitis: A national study of hospital-based emergency departments

Study Objective: Antibiotics are often used to treat viral upper respiratory tract infections, even though they are usually ineffective. However, frequent inappropriate antibiotic use contributes to the emergence of drug-resistant bacterial pathogens. This study used a national database to evaluate antibiotic use in treating upper respiratory tract infections in emergency departments. Methods: Data were obtained from the 1996 National Hospital Ambulatory Medical Care Survey. Antibiotic prescribing rates were examined for colds, upper respiratory tract infections, and acute bronchitis. Patients with comorbid conditions or secondary diagnoses, such as chronic obstructive pulmonary disease, pneumonia, sinusitis, and HIV, were excluded. Bivariate and multivariate analyses were used to assess predictors of antibiotic use. Results: Overall, there were an estimated 2.7 million ED visits for colds, upper respiratory tract infections, and bronchitis by children and adults in 1996. Antibiotics were prescribed for 24.2% (95% CI 18.9, 29.5) of patients with common colds and upper respiratory tract infections and for 42.2% (95% CI 35.2, 49.2) of patients with bronchitis. There were no significant associations between antibiotic use and patient race, sex, Hispanic ethnicity, geographic location, or source of payment. Antibiotics were prescribed less often by interns or residents than by staff or other physicians (odds ratio 0.43; 95% CI 0.19, 0.98), and patients younger than 18 years were less likely to receive antibiotics than adults (odds ratio 0.32; 95% CI 0.20, 0.52). Smokers were 4.3 (95% CI 2.2, 8.3) times more likely to receive antibiotics than nonsmokers. Conclusion: Antibiotics are commonly prescribed for ED patients with upper respiratory tract infections even though they are usually ineffective in otherwise healthy adults. Efforts should be made to reduce inappropriate antibiotic use for the sake of containing costs, preventing side effects, and limiting the spread of antibiotic resistance. [Stone S, Gonzales R, Maselli J, Lowenstein SR. Antibiotic prescribing for patients with colds, upper respiratory tract infections, and bronchitis: a national study of hospital-based emergency departments. Ann Emerg Med. October 2000;36:320-327.]

Protection of health care workers against bloodborne infections in emergency departments

Health care workers in emergency departments are at particular high risk for acquiring occupational bloodborne infections. Needle stick injuries are the main hazard. Systematic HIV testing of patients admitted to emergency department is not a cost beneficial way to protect health care workers from acquiring such infections. Prevention strategies should be based on the adherence to universal precautions, hepatitis B vaccination, the utilization of safer devices and the training/education of health care workers.

Risk of human immunodeficiency virus infection among emergency department workers

purpose: To estimate (1) the prevalence of human immunodeficiency virus (HIV) infection in emergency department (ED) patients, (2) the frequency of blood contact (BC) in ED workers (EDWs), (3) the efficacy of gloves in preventing BC, and (4) the risk of HIV infection in EDWs due to BC. patients and methods: We conducted an 8-month study in three pairs of inner-city and suburban hospital EDs in high AIDS incidence areas in the United States. At each hospital, blood specimens from approximately 3,400 ED patients were tested for HIV antibody. Observers monitored BC and glove use by EDWs. results: HIV seroprevalence was 4.1 to 8.9 per 100 patient visits in the 3 inner-city EDs, 6.1 in 1 suburban ED, and 0.2 and 0.7 in the other 2 suburban EDs. The HIV infection status of 69% of the infected patients was unknown to ED staff. Seroprevalence rates were highest among patients aged 15 to 44 years, males, blacks and Hispanics, and patients with pneumonia. BC was observed in 379 (3.9%) of 9,793 procedures; 362 (95%) of the BCs were on skin, 11 (3%) were on mucous membranes, and 6 (2%) were percutaneous. Overall procedure-adjusted skin BC rates were 11.2 BCs per 100 procedures for ungloved workers and 1.3 for gloved EDWs (relative risk = 8.8; 95% confidence interval = 7.3 to 10.3). In the high HIV seroprevalence EDs studied, 1 in every 40 full-time ED physicians or nurses can expect an HIV-positive percutaneous BC annually; in the low HIV seroprevalence EDs studied, 1 in every 575. The annual occupational risk of HIV infection for an individual ED physician or nurse from performing procedures observed in this study is estimated as 0.008% to 0.026% (1 in 13,100 to 1 in 3300) in a high HIV seroprevalence area and 0.0005% to 0.002% (1 in 187,000 to 1 in 55,000) in a low HIV seroprevalence area. conclusions: In both inner-city and suburban EDs, patient HIV seroprevalence varies with patient demographics and clinical presentation; the infection status of most HIV-positive patients is unknown to ED staff. The risk to an EDW of occupationally acquiring HIV infection varies by ED location and the nature and frequency of BC; this risk can be reduced by adherence to universal precautions.

Value of the urine dipstick test for leukocytes in screening for urinary tract infection

ABSTRACTA prospective study to assess the value of white cell detection in the urine as a screening test for urinary tract infection was carried out in an emergency department.Commercially available dipsticks were used to detect urinary leukocytes.A total of 105 adult female patients were entered into the study. The criterion for patient selection was the presence of urinary symptoms.All urine samples were cultured. The presence of pure growth of a single organism with a colony count of greater than 105CFU per millilitre was taken as proof of urinary tract infection and was compared with the dipstick result.A good negative predictive value was found in this study.Dipstick testing for urinary leukocytes may be useful in ruling out a urinary tract infection in emergency departments.

Knowledge and Practice of Nurses About the Control and Prevention of Nosocomial Infections in Emergency Departments

Background: Basic infection control measures in any nursing setup can reduce the rates of healthcare-associated infections. Reducing the risk of infection and using the prevention principles are in the realm of nursing. Objectives: The current study aimed to evaluate the level of knowledge and practices on infection control among the nursing staff. Patients and Methods: In this cross-sectional study 224 nurses were selected by random sampling from three teaching hospitals. A questionnaire was used to collect data. The questionnaire included three parts: demographic characteristic, level of knowledge, and practices among the nursing staff. Data were analyzed by SPSS software. Results: The result of the research showed that the majority of participants were female (53.6%), married (80.4%), had BS degree (89.3%) and had the working experience between 11 and 20 years (51.8%); 41.1% and 33.03% of the participants respectively had intermediate and high level of knowledge about infection control. Also the result showed that (75.8%) had intermediate level of performance in this field. There was a significant correlation between sex and performance of the participants (P = 0.014). Conclusions: According to the obtained results, the majority of nurses participating in the study had an intermediate level of knowledge and practice of infection control. There is a need to develop a system of continuous education for all the categories of nursing staff.