Infectious Diseases in Emergency Departments (INDEED)

En af de største trusler mod verdenssundheden er udviklingen af multiresistente bakterier, som er bakterier, der er modstandsdygtige over for antibiotika, og hvor helt simple infektioner kan føre til lange indlæggelser og i værste fald død. De multiresistente bakterier hænger sammen med et højt antibiotikaforbrug – jo mere antibiotika der bruges, des mere resistens. 

De hyppigste infektioner på danske hospitaler er lungebetændelse og nyrebækkenbetændelse. Disse to infektioner bidrager til et unødigt højt antibiotikaforbrug, da pålidelige og hurtige metoder til præcis diagnostik af de to tilstande mangler.

For at kunne reducere antibiotikaforbruget har lægen brug for svar inden for få timer på spørgsmålene: Er det en bakteriel infektion, som kræver antibiotika eller er det fx en virus, hvor antibiotika ingen effekt har? Hvor er infektionen lokaliseret – nyre, lunge eller et andet sted? Hvilken bakterie forårsager infektionen? Hvis alle 3 spørgsmål kan besvares, vil den behandlende læge kunne vurdere, om der skal behandles med et antibiotikum, og i så fald hvilket.

Projektet er designet som et multiinterventionsstudie, hvor patienter, der indlægges akut med mistanke om en infektion, tilbydes ekstra diagnostik udover normal behandling. Den ekstra diagnostik vil inkluderer en udvidet blodprøvediagnostik, urinundersøgelse og for nogle patienter også udvidet ekspektoratanalyse og billeddiagnostik. 
Den diagnostiske værdi af de enkelte interventioner bestemmes og sammenholdes med hinanden.

Projektet er en del af uddannelse. I projektet indgår fem ph.d.-studier, to præ-graduatstudier, og to kandidatspecialer, som ser på de enkelte interventioner hver for sig.

INDEED er et samarbejdsprojekt mellem biokemikere, mikrobiologer, radiologer, infektionsmedicinere, akutmedicinere og forskere på Sygehus Sønderjyllnad, Sygehus Lillebælt og Sygehus Sønderjylland. Projektet er forankret i Akutforskningsenheden på Sygehus Sønderjylland

Forskningsansvarlig: Christian Backer Mogensen
Overordnet projektleder: Helene Skjøt-Arkil
Radiologisk projektleder: Ole Graumann

Har du brug for at komme i kontakt med studiet, kan du kontakte projektleder Helene Skjøt-Arkil.

PROTOKOLLER

• Protokolartikel på det overordnet studie: Improved diagnostics of infectious diseases in emergency departments: a protocol of a multifaceted multicentre diagnostic study. BMJ Open 2021
• Protokolartikel på delstudie: Effectiveness of expiratory technique and induced sputum in obtaining good quality sputum from patients acutely hospitalized with suspected lower respiratory tract infection: a statistical analysis plan for a randomized controlled trial. Trials 2021

ORIGINALARTIKLER

• Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: A multicentre randomised controlled trial. PLoS Med 2023
• Expiratory Technique versus Tracheal Suction to Obtain Good-Quality Sputum from Patients with Suspected Lower Respiratory Tract Infection: A Randomized Controlled Trial. Diagnostics 2022
• Gram Stain and Culture of Sputum Samples Detect Only Few Pathogens in Community-Acquired Lower Respiratory Tract Infections: Secondary Analysis of a Randomized Controlled Trial. Diagnostics 2023 
• Can clinicians identify community-acquired pneumonia on ultralow-dose CT? A diagnostic accuracy study. Scand J Trauma Resusc Emerg Med 2024
• Diagnostic Performance of Plasma SP-D, KL-6, and CC16 in Acutely Hospitalised Patients Suspected of Having Community-Acquired Pneumonia-A Diagnostic Accuracy Study. Diagnostics 2024
• Community-acquired pneumonia: use of clinical characteristics of acutely admitted patients for the development of a diagnostic model - a cross-sectional multicentre study. BMJ Open 2024
• The Diagnostic Accuracy of Procalcitonin, Soluble Urokinase-Type Plasminogen Activator Receptors, and C-Reactive Protein in Diagnosing Urinary Tract Infections in the Emergency Department-A Diagnostic Accuracy Study. J Clin Med 2024
• Urine Flow Cytometry and Dipstick Analysis in Diagnosing Bacteriuria and Urinary Tract Infections among Adults in the Emergency Department-A Diagnostic Accuracy Trial. Diagnostics 2024
• Antibiotic Guideline Adherence at the Emergency Department: A Descriptive Study from a Country with a Restrictive Antibiotic Policy. Antibiotics 2023
• Ultra-low-dose emergency chest computed tomography protocols in three vendors: A technical note. Acta Radiol Open 2023
• Clinical characteristics, factors associated with urinary tract infection and outcome in acutely admitted patients with infection; an exploratory cross-sectional cohort study. Heliyon 2024

PHD-AFHANDLINGER

• INDEED - Diagnosis and treatment of acutely hospitalized patients with suspected community-acquired pneumonia – clinical and microbiological perspectives
  Studerende: Mariana Cartuliares, fysioterapeut
• INDEED - Urinary tract infections in Danish emergency departments – characteristics and diagnostic values of urine analysis and novel inflammatory markers
  Studerende: Mathias Amdi Hertz, læge
• INDEED - Forbedret billeddiagnostik udredning af pneumoni
  Studerende: Morten Hjarnø Lorentzen, læge

ARTIKLER PÅ VEJ

• Clinical characteristics and diagnostic accuracy of preliminary diagnoses in adults with infections in Danish emergency departments: a multicentre combined cross-sectional and diagnostic study
• Handheld ultrasound devices used by newly certified operators for pneumonia in the emergency department – A diagnostic accuracy study
• Ultra low-dose chest CT for diagnosing pneumonia in the emergency department – A diagnostic accuracy study
• CRP, IL-6, procalcitonin, suPAR, and YKL-40 in acutely hospitalized patients suspected of community-acquired pneumonia: A multivariate diagnostic model development study
• Characteristics and Antibiotic Treatment of Patients with Erysipelas in the Emergency Department
• Validity of discharge diagnosis of acutely hospitalized patients – diagnostic accuracy study
• Serological biomarker Profiling for Infection Diagnosis in Emergency Departments: A Diagnostic Study
• Prediction of infection in the emergency department – a Machine Learning model
• Characteristics of acutely admitted adults with infection of unknown origin: A multicentre descriptive cohort study
• Assessing 30-day Post-Discharge Recovery Via Daily Patient Reported Outcome Measures Following Acute Infection