[Risk factors associated with inadequacy of empirical treatment in patients with sepsis and bacteremia attended in an emergency department].

Abstract

Introduction: Management of septic patients continues to be a major challenge in emergency departments, with hospital mortality exceeding 30%. Early and appropriate administration of antibiotic therapy is an essential pillar of initial treatment for sepsis, as delays or inadequacies significantly increase morbidity and mortality. However, the factors contributing to inadequate empirical treatment are still poorly understood. The objective of our study was to identify the risk factors associated with inadequate initial treatment in patients treated as code sepsis, as well as to evaluate the impact of the initial adequacy of empirical treatment on mortality.

Material and methods: Observational, retrospective cohort study conducted in the emergency department of a tertiary hospital (2021-2024). Inclusion: adults over 18 years of age with activated sepsis codes and positive blood cultures. The adequacy of initial empirical treatment, associated risk factors, and their effect on 7- and 30-day mortality were analyzed.

Results: 339 patients with sepsis were included; 56.9% were over 80 years of age. Factors associated with inadequate antibiotic treatment were Staphylococcus aureus and multidrug-resistant bacteria. A total of 33.6% of patients received inadequate empirical treatment. Mortality was 10.9% at 7 days and 17.1% at 30 days.

Conclusion: A significant proportion of patients with sepsis in emergency departments receive inadequate empirical therapy, which is associated with higher early mortality, especially in infections caused by S. aureus and multidrug-resistant bacteria.