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Objective: Patients with suspected infections account for 15% to 35% of hospital emergency department (ED) caseloads in Spain and Latin America. The main objective of this systematic review was to compare evidence supporting the safety and efficacy of early (3 hours after triage) vs deferred ($ 3-6 hours) antibiotic therapy prescribed in EDs for adults with serious infections or sepsis. Efficacy and improved clinical course were defined by reduced progression to septic shock and short- and long-term mortality., Methods: The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). PubMed, the Web of Sciencie, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase, and ClinicalTrials.gov were searched for the period from January 1, 2010, to December 31, 2023. No language restrictions were set. We used the following Medical English Subject Headings and strings: "Antibiotic OR Antibiotic Treatment OR Antibiotic Therapy OR Early Antibiotic Treatment OR Early Antibiotic Therapy," "Infection OR Bacterial Infection OR Sepsis," "Emergencies OR Emergency OR Emergency Department," "Timing," "Early," and "Adults." Observational cohort studies were included. To evaluate quality of research design and risk of bias, we applied the Newcastle-Ottawa Scale. Case-control studies, narrative reviews and other types of articles were excluded. We completed a narrative review of the findings and did not undertake meta-analysis. The review was registered in the PROSPERO database (CRD42024520687)., Results: The search yielded 1528 articles, of which 7 met the criteria for inclusion and analysis. The 7 studies comprised data for 118349 patients, 74141 of whom (62.6%) received early antibiotic treatment. Three studies were classified as high quality, 3 moderate, and 1 low. The 3 high-quality studies provided information on 2 aspects: 1) hospital and short-term mortality and 2) long-term mortality. One high-quality study showed a tendency for hospital and 30-day mortality to increase when antibiotics were administered more than 6 hours after triage vs within 1 hour of triage (hazard ratio, 2.25; 95% CI, 0.91-5.59; P = .08). Another reported an adjusted odds ratio of 1.09 (95% CI, 1.05-1.13; P = .024) for hospital mortality associated with each hour of therapeutic delay after triage. The third study reported that each additional hour of delay after triage was associated with a 10% increase (95% CI, 5%-14%; P .001) in the probability of 360-day mortality. Finally, the single low-quality study reported that each hour of delay in treatment was associated with an odds ratio of 1.08 (95% CI, 1.02-1.04; P .001) for increased risk of septic shock., Conclusions: Early initiation of antibiotic therapy, preferably within 3 hours of triage, can be recommended in cases of serious infection (sepsis or serious sepsis that do not meet the criteria for septic shock). In fact, based on a tendency for higher short- and long-term mortality associated with delay and a higher probability of developing septic shock with each hour of delay, therapy should start as soon as possible if infection is confirmed or suspected in the absence of an alternative diagnosis.

Text: The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physiciansreviewed and analyzed the 2021 SSC guidelines from our specialty's point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians' experience- and evidence-based proposals. Secondarily, the review's recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis.

Objectives: To evaluate lactate, procalcitonin, criteria defining systemic inflammatory response syndrome (SIRS), and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality, infection with microbiologic confirmation, and true bacteremia in patients treated for infection in hospital emergency departments., Material and Methods: Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish emergency departments from October 1, 2019, to March 31, 2020. Each model's predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and predetermined decision points were assessed., Results: A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. True bacteremia was detected in 899 (20.25%), and microbiologic confirmation was on record for 2057 (46.3%). The model that included the qSOFA score (2) and lactate concentration (0.738 mmol/L; 95% CI, 0.711-0.765 mmol/L) proved to be the best predictor of 30-day mortality, with an AUC of 0.890 (95% CI, 0.880-0.901). The model that included the SIRS score (2) and procalcitonin concentration (0.51 ng/mL) proved to be the best predictor of true bacteremia and microbiologic confirmation, with an AUC of 0.713 (95% CI, 0.698-0.728)., Conclusion: A qSOFA score of 2 or more plus lactate concentration (0.738 mmol/L) predict 30-day mortality better than the combination of a SIRS score of 2 or more and procalcitonin concentration. A SIRS score of 2 or more plus procalcitonin concentration (0.51 ng/mL) predict true bacteremia and microbiologic confirmation.

Objectives: To develop a simple risk score to predict bacteremia in patients in our hospital emergency department for infection., Material and Methods: Retrospective observational cohort study of all blood cultures ordered in the emergency department for adults (aged 18 or older) from July 1, 2018, to March 31, 2019. We gathered data on 38 independent variables (demographic, comorbidity, functional status, and laboratory findings) that might predict bacteremia. Univariate and multiple logistic regression analyses were applied to the data and a risk scale was developed., Results: A total of 2181 blood samples were cultured. True cases of bacteremia were confirmed in 262 (12%). The remaining 1919 cultures (88%) were negative. No growth was observed in 1755 (80.5%) of the negative cultures, and 164 (7.5%) were judged to be contaminated. The 5MPB-Toledo model identified 5 predictors of bacteremia: temperature higher than 38.3°C (1 point), a Charlson comorbidity index of 3 or more (1 point), respiratory frequency of at least 22 breaths/min (1 point), leukocyte count greater than 12 000/mm3 (1 point), and procalcitonin concentration of 0.51 ng/mL or higher (4 points). 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 1.1%, 10.5%, and 77%, respectively. The model's area under the receiver operating characteristic curve was 0.946 (95% CI, 0.922-0.969)., Conclusion: The 5MPB-Toledo score could be useful for predicting bacteremia in patients attended in hospital emergency departments for infection.