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Erdem H, Baymakova M, Alkan S, Letaief A, Yahia WB, Dayyab F, Kolovani E, Grgic S, Cosentino F, Hasanoglu I, Khedr R, Marino A, Pekok AU, Eser F, Arapovic J, Guner HR, Miftode IL, Poposki K, Sanlidag G, Tahmaz A, Sipahi OR, Miftode EG, Oncu S, Cagla-Sonmezer M, Addepalli SK, Darazam IA, Kumari HP, Koc MM, Kumar MR, Sayana SB, Wegdan AA, Amer F, Ceylan MR, El-Kholy A, Onder T, Tehrani HA, Hakamifard A, Kayaaslan B, Shehata G, Caskurlu H, El-Sayed NM, Mortazavi SE, Pourali M, Elbahr U, Kulzhanova S, Yetisyigit T, Saad SA, Cag Y, Eser-Karlidag G, Pshenichnaya N, Belitova M, Akhtar N, Al-Majid F, Ayhan M, Khan MA, Lanzafame M, Makek MJ, Nsutebu E, Cascio A, Dindar-Demiray EK, Evren EU, Kalas R, Kalem AK, Baljić R, Ikram A, Kaya S, Liskova A, Szabo BG, Rahimi BA, Mutlu-Yilmaz E, Sener A, Rello J. Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study. Eur J Clin Microbiol Infect Dis 2023; 42:387-398. [PMID: 36790531 PMCID: PMC9930069 DOI: 10.1007/s10096-023-04561-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19-3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65-1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65-1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey
| | - Magdalena Baymakova
- Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Amel Letaief
- Department of Infectious Diseases, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
| | - Wissal Ben Yahia
- Department of Infectious Diseases, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
| | - Farouq Dayyab
- Department of Internal Medicine, King Hamad University Hospital, Al Sayh, Manama, Bahrain
| | - Entela Kolovani
- Infectious Disease Clinic, University Hospital Center 'Mother Theresa', Tirana, Albania
| | - Svjetlana Grgic
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Federica Cosentino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Imran Hasanoglu
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute - Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Andrea Marino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | | | - Fatma Eser
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Jurica Arapovic
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Hatice Rahmet Guner
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Kostadin Poposki
- Faculty of Medicine, University Clinic for Infectious Diseases and Febrile Conditions, Skopje, Republic of North Macedonia
| | - Gamze Sanlidag
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
| | - Alper Tahmaz
- Department of Infectious Diseases & Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Oguz Resat Sipahi
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
| | | | - Serkan Oncu
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Meliha Cagla-Sonmezer
- Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Turkey
| | - Syam Kumar Addepalli
- Department of Pharmacology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh, India
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hema Prakash Kumari
- Department of Microbiology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh, India
| | - Meliha Meriç Koc
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Meela Ranjith Kumar
- Department of Pharmacology, Government Medical College &, Government General Hospital, Suryapet, Telangana, India
| | - Suresh Babu Sayana
- Department of Pharmacology, Government Medical College, Suryapet, Telangana, India
| | - Ahmed Ashraf Wegdan
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mehmet Resat Ceylan
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Taylan Onder
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Hamed Azhdari Tehrani
- Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bircan Kayaaslan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Seyed Erfan Mortazavi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Pourali
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Umran Elbahr
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Tarkan Yetisyigit
- Department of Oncology, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
| | - Sahar Ahmed Saad
- Department of Rheumatology, King Hamad Univesity Hospital, Al Sayh, Bahrain
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Gulden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | | | | | - Nasim Akhtar
- Pakistan Institute of Medical Sciences, Islamabad, G-8/3, Pakistan
| | - Fahad Al-Majid
- Department of Medicine, Infectious Diseases Division, King Saud University, Riyadh, Saudi Arabia
| | - Muge Ayhan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | | | | | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Palermo, Italy
| | | | - Emine Unal Evren
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, University of Kyrenia, Kyrenia, Cyprus
| | - Rama Kalas
- Internal Medicine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Bilal Ahmad Rahimi
- Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
| | - Esmeray Mutlu-Yilmaz
- Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Alper Sener
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Jordi Rello
- Clinical Research and Epidemiology in Pneumonia and Sepsis, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Clinical Research, CHRU Nîmes, Nîmes, France
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Erdem H, Hargreaves S, Ankarali H, Caskurlu H, Ceviker SA, Bahar-Kacmaz A, Meric-Koc M, Altindis M, Yildiz-Kirazaldi Y, Kizilates F, Alsalman J, Cag Y, Kamal AHM, Dokmetas I, Dindar-Demiray EK, Shehata GA, Hasman H, Sadykova A, Llopis F, Ramosaco E, Logar M, Alay H, Kesmez-Can F, Ruch Y, Bulut D, Makek MJ, Marino A, Mahboob A, El-Kholy A, Abdallah D, Sefa-Sayar M, Karaali R, Aslan S, Dar RE, Abdalla E, Monzón-Camps H, Baljić R, Mgdalena DI, Naghili B, Abbas Dafalla ME, Alwashmi ASS, Carmen CR, Ramirez-Estrada S, Wojewodzka-Zelezniakowicz M, Akyildiz O, Zajkowska J, El-Sokkary R, Pandya N, Amer F, Alavi-Darazam I, Grgić S, Wegdan AA, El-Kholy J, Bulut-Avsar C, Kulzhanova S, Tasbakan M, Kumari HP, Dirani N, Koganti K, Konkayev AK, Petrov MM, Cascio A, Liskova A, Del Vecchio RF, Lambertenghi L, Mladenov N, Oncu S, Rello J. Managing adult patients with infectious diseases in emergency departments: international ID-IRI study. J Chemother 2021; 33:302-318. [PMID: 33734040 DOI: 10.1080/1120009x.2020.1863696] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.
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Affiliation(s)
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sevil Alkan Ceviker
- Department of Infectious Diseases and Clinical Microbiology, Kutahya Evliya Celebi Research and Education Hospital, Kutahya, Turkey
| | - Asiye Bahar-Kacmaz
- Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Mustafa Altindis
- Department of Medical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | | | - Filiz Kizilates
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Health Sciences University, Antalya, Turkey
| | | | - Yasemin Cag
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Ilyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | | | | | - Hakan Hasman
- Emergency Department, Ankara Medicalpark Hospital, Ankara, Turkey
| | - Ainur Sadykova
- Department of Infectious and Tropical Diseases, City Clinical Infectious Hospital, Kazakh National Medical University, Almaty, Kazakhstan
| | - Ferran Llopis
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ergys Ramosaco
- Infectious Diseases Clinic, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Mateja Logar
- Department of Infectious Diseases, UMC Ljubljana, Ljubljana, Slovenia
| | - Handan Alay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Fatma Kesmez-Can
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Yvon Ruch
- Department of Infectious Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Dilek Bulut
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | | | - Andrea Marino
- Department of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Amjad Mahboob
- Bacha Khan Medical Complex Swabi, Khyber Pakhtunkhwa, Pakistan
| | | | - Dirar Abdallah
- Department of Intensive Care, Prime Hospital, Dubai, United Arab Emirates
| | - Merve Sefa-Sayar
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | - Ridvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, İstanbul Üniversitesi, Istanbul, Turkey
| | - Selda Aslan
- Department of Infectious Diseases and Clinical Microbiology, Cengiz Gokcek Maternity and Children's Hospital, Gaziantep, Turkey
| | - Razi Even Dar
- Department of Internal Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Esam Abdalla
- Department of Anesthesia & ICU, Assiut University Hospital, Assiut, Egypt
| | - Helena Monzón-Camps
- Emergency Department and Infectious Diseases, Hospital Universitary Mútua Terrassa, Terrassa, Spain
| | - Rusmir Baljić
- Clinic for Infectious Diseases, Sarajevo, Bosnia and Herzegovina
| | - Dumitru Irina Mgdalena
- Clinical Infectious Diseases Hospital, Ovidius University of Constanta, Constanta, Romania
| | - Behrouz Naghili
- Department of Infectious Diseases, Imam Reza Hospital, Tabriz, Iran
| | | | - Ameen S S Alwashmi
- Medical Laboratories Department, College of Applied Medical Sciences, Qassim University, Saudi Arabia
| | - Cernat Roxana Carmen
- Clinical Hospital for Infectious Diseases, Ovidius University Constanta, Constanta, Romania
| | | | | | - Ozay Akyildiz
- Department of Infectious Diseases and Clinical Microbiology, Adana Acibadem Hospital, Adana, Turkey
| | | | - Rehab El-Sokkary
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ilad Alavi-Darazam
- Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Svjetlana Grgić
- Clinic for Infectious Disease, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | | | - Cansu Bulut-Avsar
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkey
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkey
| | | | | | | | - Aidos K Konkayev
- Institution of Trauma and Orthopaedics, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Michael M Petrov
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University, Plovdiv, Bulgaria
| | - Antonio Cascio
- Infectious and Tropical Diseases Section, Department PROMISE, University of Palermo, Palermo, Italy
| | | | | | | | | | - Serkan Oncu
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Jordi Rello
- Critical Care Department, Hospital Vall d'Hebron, Barcelona, Spain.,CIBERES, Madrid, Spain.,Universitat Autonma de Barcelona, Barcelona, Spain
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