Infectious diseases and clinical microbiology consultations in the emergency department: A cross-sectional study at a tertiary-care hospital

Background: Although there is limited data about the role of infectious diseases and clinical microbiology(IDCM) consultations in the Emergency Department (ED), they have a key role in deciding on hospitalizationand appropriate use of antibiotics.Objectives: To evaluate demographic and clinical characteristics of patients who visited the ED of our hospitaland underwent an IDCM consultation.Materials and methods: In this cross-sectional study, were viewed the medical records of adult patientswho visited the ED of our hospital between May and August 2021 and needed IDCM consultation. The demographic data, the date and time of admission and consultation, the departments that were consultedbefore IDCM, laboratory results, diagnosis, and outcome were recorded.Results: Out of 42,116 ED visits, 1,007 (2.4%) IDCM consultations were requested. The median time between admission and IDCM consultation was 239 min (150.0–373.5). Before 56.9% of IDCM consultations,pre-consultations were requested from other departments, and the time interval was significantly longer.The median age of patients was 68 years (51–77years). Infections were confirmed by the IDCM physicianin 79.6% of the consultations. The most diagnosed infections were urinary tract infections (32.4%), skin-softtissue infections (16.9%) and lower respiratory tract infections (10.3%), whereas 9.3% of the consultationsresulted in hospitalization to the infection ward, 25.1% to other wards, and 5% to the intensive care unit (ICU).Conclusions: Two of 3 consultations resulted in hospitalization in other wards, and this shows that IDCMconsultations are beneficial for managing patients with infectious diseases hospitalized in other departments.Communication between IDCM specialists and ED colleagues is important, especially in the managementof elderly patients who require a multidisciplinary approach.</p

Clinical outcomes and independent risk factors for 90-day mortality in critically ill patients with respiratory failure infected with sars-cov-2: A multicenter study in turkish intensive care units

Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P 2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2 /FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality. Copyright@Author(s)