Early screening of risk for multi-drug resistant organisms in the emergency department in patients with pneumonia and early septic shock: single-center, retrospective cohort study

Abstract Background Pneumonia is the fourth leading cause of death globally, with rapid progression during septic shock. Multidrug-resistant organisms (MDROs) are becoming more common with some healthcare-associated pneumonia events. Early detection of MDRO risk may improve the outcomes; however, the risk of MDROs in patients with pneumonia and septic shock is unknown and may need broad spectrum multidrug antibiotic therapy. This study investigated the disease outcomes and multidrug antibiotic therapy of pneumonia with early septic shock in patients admitted in the emergency department (ED), a population with a high prevalence of MDROs, after early screening of MDROs risk. Methods In this retrospective cohort study, patients with pneumonia and sepsis (n=533) admitted to the ED at the Taipei Tzu Chi Hospital from 2013 to 2019 were enrolled. The study population was divided into the high-risk and low-risk groups (patients from the communities or long-term care facilities with high and low prevalence of MDROs) and further divided into four subgroups to those whose screening procedure completed within 1 or 6 h of admission (high-risk within 1 h, high-risk within 6 h, low-risk within 1 h, and low risk within 6 h groups). The ICU mortality and multidrug antibiotic therapy were compared. Results The high-risk MDROs groups had higher percentage of P. aeruginosa than the low-risk group. Furthermore, the appropriate ED first antibiotics were higher in the “within 1 h” than in the “within 6 h” subgroup of the high-risk MDROs group. In multivariate analysis, the “within 6 h” high-risk MDROs subgroup had an adjusted odds ratio of 7.191 (95% CI: 2.911–17.767, p <0.001) and 2.917 (95% CI:1.456–5.847, p=0.003) for the ICU mortality and multidrug therapy in the ICU, respectively, after adjusting for other confounding factors. Conclusions Delayed MDRO screening in the high risk group had significant higher ICU mortality and multidrug antibiotic therapy in patients with pneumonia and early septic shock in the ED, especially in areas with a high prevalence of MDROs.