Hrev_master ecjemergency care journal w w w .e cj .it s1 21 Issue s1 2025 Editor-in-Chief Lorenzo Ghiadoni, Italy pISSN 1826-9826 eISSN 2282-2054 PAGEPress - Scientific Publications Via A. Cavagna Sangiuliani, 5 - 27100 Pavia - Italy Phone +39 0382 464340 - Fax +39 0382 34872 www.pagepress.org e m e r g e N c y c a r e j o u r N a l – e c j 2 0 2 5 – v o l u m e 2 1 – S 1 Emergency Care Journal pISSN 1826-9826 | eISSN 2282-2054 Editor-in-Chief Lorenzo Ghiadoni Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy Journal Founder and Senior Editor Ivo Casagranda Past Director, Medicina e Chirurgia d’Accettazione e d’Urgenza, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy Associate Editors Mario Cavazza, Dipartimento dell'Emergenza-Urgenza, Policlinico S. Orsola-Malpighi, Bologna, Italy Gianfranco Cervellin, Dipartimento di Emergenza-Urgenza, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy Daniele Coen, Dipartimento di Emergenza-Urgenza, Ospedale Niguarda Ca’ Granda, Milano, Italy Egidio Imbalzano, Department of Clinical and Experimental Medicine, University of Messina, Italy Assistant Editors Greta Barbieri, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa; Emergency Medicine Department, Pisa University Hospital, Italy Erika Poggiali, Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy Francesco Salinaro, Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Veronica Salvatore, Emergency Department, Division of Medicina d'urgenza e Pronto Soccorso, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy Editorial Board Members Paolo Aseni, Dipartimento di Emergenza, Grande Ospedale Metropolitano Niguarda, Milan, Italy Andrea Bellone, Past-director SC Pronto Soccorso e Medicina d'Urgenza ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy Michele Brignole, UO Cardiologia Istituto Auxologico Italiano, Milano, Italy Maurizio Catino, Dipartimento di Sociologia e Ricerca Sociale, Università di Milano - Bicocca, Milano, Italy Giorgio Costantino, UOC Prontosoccorso e Medicina d’Urgenza, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico Università degli Studi di Milano, Italy Francesco Cristini, Dipartimento Malattie Apparato Digerente e Medicina Interna, Policlinico S.Orsola- Malpighi, Bologna, Italy Kathleen Davenport, Geriatric Emergency Medicine, University of Chapel Hill, NC, USA Fabrizio Giostra, Dipartimento di Emergenza-Urgenza, Policlinico S.Orsola-Malpighi, Bologna, Italy Carlo Locatelli, Centro Antiveleni di Pavia, Pavia, Italy Marcello Lanari, Pediatria d'Urgenza e Pronto Soccorso Pediatrico, Policlinico Sant'Orsola-Malpighi, Bologna, Italy Davide Lonati, Centro Antiveleni di Pavia, IRCCS Fondazione Maugeri, Pavia, Italy Maria Lorenza Muiesan, Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia, Italy Claire G. Nicholl, Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK Filippo Numeroso, UOC Pronto Soccorso e Medicina d’Urgenza, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy Ciro Paolillo, SC Pronto Soccorso, Azienda Ospedaliera Universitaria di Verona, Italy Stefano Perlini, Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Italy Vito Marco Ranieri, Department of Emergency and Intensive Care Medicine, IRCCS Policlinico di Sant'Orsola, University of Bologna, Italy Matthew James Reed, University of Edinburgh, United Kingdom Łukasz Szarpak, Department of Emergency Medicine, Medical University of Warsaw, Poland Roberto Testi, Medicina Legale, ASLTO 2, Torino, Italy Andrea Ungar, UOC Geriatria, Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Italy Editorial Staff Maria Teresa Carrrara, Managing Editor Cristiana Poggi, Production Editor Tiziano Taccini, Technical Support Publisher PAGEPress Publications Via A. Cavagna Sangiuliani 5 27100 Pavia, Italy Tel. +39.0382.1549020 – Fax. +39.0382.1727454 info@pagepress.org – www.pagepress.org Prof. Gianni Biolo Professore Associato - Università degli Studi di Trieste Direttore SC (UCO) Clinica Medica ASU GI Azienda sanitaria universitaria Giuliano Isontina, Trieste Dottor Filippo Giorgio Di Girolamo Ricercatore Universitario – Università degli Studi di Trieste Farmacista Ospedaliero SC Assistenza Farmaceutica ASU GI Azienda sanitaria universitaria Giuliano Isontina, Trieste Dottor Filippo Mearelli Dirigente Medico SC (UCO) Clinica Medica ASU GI Azienda sanitaria universitaria Giuliano Isontina, Trieste RESPONDABILI SCIENTIFICI Giorgio Berlot (TS) Elisa Baratella (TS) Alan Biloslavo (TS) Marina Bortul (TS) Tiziana Bove (UD) Marina Busetti (TS) Mario Calci (UD) Stefano Cernic (TS) Venera Costantino (TS) Stefano Di Bella (TS) Vittorio Di Maso (TS) Andrea Fabbri (FC) Francesco Franceschi (RM) Antonio La Greca (RM) Roberto Luzzati (TS) Luigi Murena (TS) Daniele Orso (UD) Alberto Peratoner (TS) Gabriele Sganga (RM) Francesca Sirianni (TS) Carlo Tascini (UD) COMITATO SCIENTIFICO PATROCINI Table of Contents BioFire® Joint Infection Panel for samples other than synovial fluid. A case series ..............................1 Predictors of mortality in septic patients .......................................................................................................3 Prognostic Role of the Arterial-Venous pCO2 Gap Calculated on Peripheral Venous Blood in Septic Patients in the Emergency Department .........................................................................................................6 A new device for the treatment of sepsis: the functionalized cartridge .....................................................7 Assessment of antibiotic concentrations in abdominal abscesses: protocol of a prospective study........8 A rare case of dizziness....................................................................................................................................9 CD169 and HLA-DR in blood cells and circulating extracellular vesicles in COVID-19 as markers infection and post-acute sequelae monitoring............................................................................................10 Septic shock and infective endocarditis from toxigenic Corynebacterium diphtheriae.........................12 Management of acute pyelonephritis in the EDOU and in the regular ward ..........................................15 Emergency Care Journal volume 21, supplementary 1, 2025 SEPSIS TRIESTE 2024 - 2nd Edition Generali Convention Center Trieste 20 e 21 settembre 2024 ABSTRACT BOOK SEPSIS TRIESTE 2024 - 2nd Edition - Trieste, 20 e 21 settembre 2024 [Emergency Care Journal 2025; 21(s1)] [page 1] EARLY MICROBIOLOGICAL DIAGNOSIS BIOFIRE® JOINT INFECTION PANEL FOR SAMPLES OTHER THAN SYNOVIAL FLUID. A CASE SERIES Nicola Benvenuto,1 Stefano Di Bella,2 Luigi Principe,3 Diego Luppino,1 Jacopo Conti,1 Venera Costantino,4 Manuela Di Santolo,4 Marina Busetti,4 Roberto Luzzati,2 Verena Zerbato1* E-mail: nicola.benvenuto98gmail.com 1Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste; 2Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste; 3Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria; Venera Costantino, Manuela Di Santolo, Marina Busetti: Microbiology Unit, Trieste University Hospital (ASUGI), Trieste, Italy *Corresponding author: Dr. Verena Zerbato, Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale n°1, 34125 Trieste, Italy - verena.zerbato@gmail.com Objectives. Early identification of infection-causing microorgan- isms through multiplex PCR panels enables prompt and targeted antibiotic therapy. This study aimed to assess the performance of the BioFire® Joint Infection Panel (BF-JIP) in analysing non-syn- ovial fluid samples compared to traditional culture methods. To our knowledge this is the first study to evaluate BF-JIP in a broader context, beyond bone and joint infections. Some authors have explored the “off-label” use of other multiplex PCR panels. Micó et al. investigated the use of the blood FilmArray panel on non- blood samples (e.g. cerebrospinal, joint, pleural, ascitic and abscesses fluids, finding an overall concordance with culture- based methods of 75% [1]. Hirai et al. evaluated the blood FilmArray panel for bone and joint infection, showing a sensitivity of 100% when considering only pathogens that are included in the panel [2]. Design. Retrospective cohort study. Setting. Trieste University Hospital, Italy Interventions. None Methods and main results. We conducted a retrospective cohort study at Trieste University Hospital, Italy, including all hospital- ized adult patients who had at least one non-synovial fluid sample tested by both the BioFire Joint Infection Panel (BF-JIP) and tra- ditional culture methods (gold standard) between November 2022 and April 2024 (Figure 1). To assess the performance of the BF- JIP, a suite of statistical metrics was calculated, including percent- age of positive agreement (PPA), percentage of negative agree- ment (NPA), positive predictive value (PPV), negative predictive value (NPV), enhanced detection, concordance (C), and accuracy (A). A total of 48 non-synovial fluid samples from 45 patients were evaluated, representing a diverse set of clinical scenarios. The patient cohort had a median age of 63 years, with a notable portion (67%) receiving antibiotic therapy at the time of sample collection. The types of samples included 24 abscess drainage fluids (e.g. cerebral, abdominal, skin and soft tissue abscesses, as well as infections related to breast implants), 10 biopsies (mainly bone tis- sue samples collected during surgical procedures), 6 pleural fluid samples, 5 cerebrospinal fluid (CSF) samples, 2 ascitic fluid sam- ples, and 1 vitreous/aqueous humor sample. BF-JIP demonstrated an overall concordance rate of 85.4% with traditional culture meth- ods, achieving particularly high accuracy in CSF samples, where it reached 100% concordance and accuracy (Table 1). Additionally, its accuracy was recorded at 89.6%. The BF-JIP detected 42 bacteria and 2 fungi (Table 2), effec- tively identifying anaerobic bacteria in polymicrobial infections that traditional culture missed. This resulted in a 4.3% increase in Figure 1. A) Pie chart representing sources of primary infection. B) Histogram representing age classes divided by gender. C) Boxplots showing MDW values dispersion at ICU admission and sites of primary infection. Emergency Care Journal 2025; volume 21(s1) [page 2] [Emergency Care Journal 2025; 21(s1)] the detection rate compared to standard culture methods. Even in patients undergoing antibiotic therapy, BF-JIP maintained robust performance. The comprehensive analysis confirmed BF-JIP’s efficacy in critical samples such as CSF and abscess drainage flu- ids, highlighting its potential to improve patient management in complex clinical settings. Conclusions. The BF-JIP demonstrated strong performance in detecting pathogens in non-synovial fluid samples, with high con- cordance (85.4%) and 4.3% enhanced detection compared to tradi- tional culture methods. Notably, its accuracy was 89.6%, consis- tent with previous studies on synovial fluid where BF-JIP showed excellent sensitivity and specificity, as well as faster turnaround times [3,4]. References 1. Agnello L, Bivona G, Vidali M, Scazzone C, Giglio RV, Iacolino G, et al. Monocyte distribution width (MDW) as a screening tool for sepsis in the Emergency Department. Clin Chem Lab Med. 2020;58(11):1951-1957. Doi: 10.1515/cclm- 2020-0417. 2. Piva E, Zuin J, Pelloso M, Tosato F, Fogar P, Plebani M. Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units. Clin Chem Lab Med. 2021;59(7):1307-1314. Doi: 10.1515/cclm-2021-0192. 3. Agnello L, Ciaccio AM, Del Ben F, Lo Sasso B, Biundo G, Giglia A, Giglio RV, Cortegiani A, Gambino CM, Ciaccio M. Monocyte distribution width (MDW) kinetic for monitoring sepsis in intensive care unit. Diagnosis (Berl). 2024 Apr 22. doi: 10.1515/dx-2024-0019. Epub ahead of print. 4. Wardi G, Tainter CR, Ramnath VR, Brennan JJ, Tolia V, Castillo EM, Hsia RY, Malhotra A, Schmidt U, Meier A. Age- related incidence and outcomes of sepsis in California, 2008- 2015. J Crit Care. 2021 Apr;62:212-217. doi: 10.1016/j.jcrc.2020.12.015. Epub 2020 Dec 23. Table 1. Performances of the BF-JIP. A = accuracy; C = concordance; NPA = percentage of negative agreement; NPV = negative predictive value; PPA = percentage of positive agreement; PPV = positive predictive value. Table 2. Microorganisms detected by the Biofire® Joint Infection panel (BF-JIP). RESUSCITATION AND MONITORING PREDICTORS OF MORTALITY IN SEPTIC PATIENTS Matteo Fabris1,2,*, Francesco Meroi2, Annarita Tullio1, Manuela Lugano2, Tiziana Bove1,2 1Department of Medicine (DMED), University of Udine; 2Department of Anaesthesia and Intensive Care Medicine, ASUFC, University Hospital of Udine, Italy *E-mail: matteo.fabris@outlook.com Objectives. Monocyte distribution width (MDW) represents monocytes volume dispersion around the mean value [1]. It is a known early marker for sepsis among patients recovered in ICU [2]. The primary aim of this study was to evaluate whether MDW could be an appropriate indicator of 30-days mortality among patients admitted to intensive care unit (ICU) with sepsis. The sec- ondary objective was to verify whether MDW value at ICU admis- sion correlates with mortality. Design. Retrospective, single centre study. Setting. ICU and ward. Subjects. MDW values of patients diagnosed with sepsis admitted in ICU. Interventions. None Methods and main results. We retrospectively enrolled patients with a diagnosis of sepsis and admitted to ICU between August 15, 2023, and July 15, 2024, at Santa Maria della Misericordia Hospital, Udine, Italy. Only patients who underwent daily MDW evaluation during ICU recovery were included. Patients less than eighteen years old were not included. For each patient, demo- graphic data, recovery length, site of infection and daily MDW val- ues were collected. 43 patients met the eligibility criteria. The pop- ulation accounted for 25 females (58.1%) and 18 males (41.9%), with a median age of 69.9±13.6 years (Figure 1). The mean recov- SEPSIS TRIESTE 2024 - 2nd Edition - Trieste, 20 e 21 settembre 2024 [Emergency Care Journal 2025; 21(s1)] [page 3] Figure 1. A) Pie chart representing sources of primary infection. B) Histogram representing age classes divided by gender. C) Boxplots showing MDW values dispersion at ICU admission and sites of primary infection. Emergency Care Journal 2025; volume 21(s1) Figure 2. Boxplots representing ICU mortality sorted by age. [page 4] [Emergency Care Journal 2025; 21(s1)] Table 1. Mortality and MDW values by primary infection site. Table 2. Statistical significance level between the analyzed variables. ery length was 11.7±13.0 days. 11 patients (25.6%) died within ICU whereas 3 patients (7.0%) died after discharge to the ward; the overall mortality within 30 days after ICU admission was of 14 patients (32.6%). Abdominal infection was the most frequent source of sepsis (30.2%) as well as the main cause of 30-days mor- tality after recovery (38.5%) (Table 1 and Figure 1). Bile duct infection instead showed the highest ICU mortality (42.9%) (Table 1). Statistical analysis for continuous variables was conducted using Welch two sample t-test or Wilcoxon rank sum test with con- tinuity correction, according to Kolmogorov-Smirnov normality test results. For categorical variables, chi-square test or Fisher’s exact test were used. Our results demonstrate that MDW value at ICU admission does not correlate with ICU mortality (p-value 0.780), neither does the maximum value detected among ICU recovery (p-value 0.962) (Table 2). The primary outcome was not fulfilled: MDW values at ICU admission do not predict 30-days mortality (p-value 0.437). Similarly, MDW values at ICU dis- charge do not predict mortality in the further 30 days (p-value 0.551). According to our analysis, age is the strongest single pre- dictor of ICU mortality (p<0.001) but it does not predict mortality within 30 days after ICU dismission (p-value 0.577). The mean age of patients who survived after ICU admission was 66.3±13.2 years whereas the mean age of patients who experienced death among ICU recovery was about 80.3±8.7 years (Figure 2). Conclusions. Our study confirmed how MDW alone could not be used as a single predictor of mortality for septic patients [3], nei- ther it could be employed as a single predictor of 30-days mortality after ICU discharge. Age > 65 years old is a risk factor for mortal- ity among septic patients [4], condition attributable to comorbidi- ties and lower organ function reserve. According to our evaluation, age is the strongest single predictor of ICU mortality. References 1. Agnello L, Bivona G, Vidali M, Scazzone C, Giglio RV, Iacolino G, et al. Monocyte distribution width (MDW) as a screening tool for sepsis in the Emergency Department. Clin Chem Lab Med. 2020;58(11):1951-1957. Doi: 10.1515/cclm- 2020-0417. 2. Piva E, Zuin J, Pelloso M, Tosato F, Fogar P, Plebani M. Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units. Clin Chem Lab Med. 2021;59(7):1307-1314. Doi: 10.1515/cclm-2021-0192. 3. Agnello L, Ciaccio AM, Del Ben F, Lo Sasso B, Biundo G, Giglia A, Giglio RV, Cortegiani A, Gambino CM, Ciaccio M. Monocyte distribution width (MDW) kinetic for monitoring sepsis in intensive care unit. Diagnosis (Berl). 2024 Apr 22. doi: 10.1515/dx-2024-0019. Epub ahead of print. 4. Wardi G, Tainter CR, Ramnath VR, Brennan JJ, Tolia V, Castillo EM, Hsia RY, Malhotra A, Schmidt U, Meier A. Age- related incidence and outcomes of sepsis in California, 2008- 2015. J Crit Care. 2021 Apr;62:212-217. doi: 10.1016/ j.jcrc.2020.12.015. Epub 2020 Dec 23. SEPSIS TRIESTE 2024 - 2nd Edition - Trieste, 20 e 21 settembre 2024 [Emergency Care Journal 2025; 21(s1)] [page 5] EARLY DIAGNOSIS AND TREATMENT OF ORGAN DYSFUNCTION PROGNOSTIC ROLE OF THE ARTERIAL-VENOUS PCO2 GAP CALCULATED ON PERIPHERAL VENOUS BLOOD IN SEPTIC PATIENTS IN THE EMERGENCY DEPARTMENT Maria Lumare, Michele C. Santoro, Maurizio Gabrielli, Roberta Di Luca, Licia A. Scatà, Martina Malaspina, Alberto Manno, Maria Rita Morabito Loprete, Dario Giani, Valerio Picardi, Andrea Piccioni, Marcello Candelli, Marcello Covino, Francesco Franceschi Università Cattolica del Sacro Cuore, Fondazione Policlinico Gemelli, Dipartimento Medicina d’Urgenza e Pronto Soccorso, Italy E-mail: lumaremaria@gmail.com Objectives. The arterial-venous pCO2 gap (A-VpCO2 gap) is a marker used to evaluate tissue perfusion and cardiac output, typi- cally considered normal when it is less than 6 mmHg. Traditionally, this measurement is calculated using central venous blood, and prior research has shown that an elevated A-VpCO2 gap (>6 mmHg) is associated with poor prognosis in septic patients. However, in fast-paced and crowded environments like the Emergency Department (ED), obtaining central venous blood may not always be feasible. Recent studies suggest that peripheral venous blood could be a reliable alternative for calculating the A- VpCO2 gap. The primary aim of this study was to assess whether the A-VpCO2 gap, calculated using peripheral venous blood (A- PVpCO2 gap), correlates with 7-day mortality in patients present- ing with sepsis to the ED. Design and setting. This study was a single-center, observational, prospective analysis conducted at the “Agostino Gemelli” University Hospital in Rome. Between May 2021 and May 2023, patients over the age of 18 who presented to the ED with sepsis were enrolled. Upon arrival, each patient underwent simultaneous arterial and peripheral venous blood gas analysis. Data collected included vital signs, routine laboratory tests, and inflammatory markers. Patients. Patients were classified into two groups based on the SOFA and APACHE-II scores: a low-risk group (SOFA <7, APACHE-II <15) and a medium-high-risk group (patients not meeting the low-risk criteria). Statistical significance was defined as a p-value of ≤ 0.05. Intervention: None Results:A total of 121 patients were included in the study, with an average age of 72.6 years (±13.2), and 71.5% of them were male. Several factors were statistically associated with 7-day mortality, including lower systolic blood pressure (101.1±24.0 vs 118.5±24.6 mmHg), lower diastolic blood pressure (59.9±13.0 vs 70.1±14.1 mmHg), lower C-reactive protein (CRP) levels (93.8±50 vs 185.3±119.1 mg/L), higher lactate levels (5.9±3.3 vs 2.3±4.4 mmol/L), and higher SOFA and APACHE-II scores (93% vs 51% and 71.4% vs 30.5%, respectively). Although the A-PVpCO2 gap was higher in patients with worse outcomes (10.3±4.7 vs 7.8±5.7 mmHg), this difference was not statistically significant (p=0.08). ROC curve analysis (AUC=0.65) indicated that an A- PVpCO2 gap of 6.75 mmHg was the most accurate cut-off value for predict- ing 7-day mortality, with a sensitivity of 92.9% and specificity of 50.5%. Additionally, Pearson correlation analysis showed a signif- icant association between the A-PVpCO2 gap and lactate levels (R=0.235, p=0.01). Conclusions. The study suggests that the A-PVpCO2 gap tends to be higher in septic patients with poorer outcomes, although this finding did not reach statistical significance. A cut-off value of 6.75 mmHg was identified as a potential marker for better progno- sis, which aligns closely with the established cut-off of 6 mmHg for central venous blood and with previous studies (e.g., Wei Gao et al., 2018). The study’s limitations include a small sample size, the absence of simultaneous A- VpCO2 gap measurements using central venous blood, and patient heterogeneity within the ED set- ting. These factors suggest that further research with a larger and more controlled sample is necessary to validate the prognostic use of the A-PVpCO2 gap in septic patients. Emergency Care Journal 2025; volume 21(s1) [page 6] [Emergency Care Journal 2025; 21(s1)] ANTIMICROBIAL THERAPY A NEW DEVICE FOR THE TREATMENT OF SEPSIS: THE FUNCTIONALIZED CARTRIDGE de Cal Massimo*,1,2, Lorenzin Anna1,2, Perin Natascha1,2, Ronco Claudio1,2, Zanella Monica1 1Dept of Nephrology, San Bortolo Hospital, Vicenza; 2IRRIV Foundation, Vicenza, Italy E-mail: massimo.decal@aulss8.veneto.it Objectives. The efficacy of an antibiotic Functionalized Cartridge (FC) in reducing the circulating bacterial load during hemoadsorp- tion treatment. Design. Recent studies had proposed the utilization of drug- or antibiotic-FC in sepsis management. This in vitro study evaluated the impact of a FC on circulating bacterial load and compared it to a standard sepsis treatment using antibiotic and extracorporeal treatment with a Non-Functionalized Cartridge (NFC). The time to positivity (TTP), which provides indirect information on bacteria concentration, was used to evaluate the effect of treatments with FC and NFC. Setting. In vitro hemoadsorption was performed using GALILEO testing platform (IRRIV Laboratory) with minimodule of HA380 cartridge (Jafron, Zhuhai, China). Subjects. Staphylococcus aureus bacteria MSSA in heparinized blood Interventions. None Methods and main results. S.aureus were injected into 2L blood and incubated for 24h. After 24h, a sample was taken (T0) and the blood was divided into 4 bags: A and B of 700mL, X and Y, nega- tive control of A and B respectively of 300mL. 70mg and 30mg of Vancomycin were inoculated into B and Y, respectively, and incu- bated together with other bags for 1h. A HA380 minimodule was functionalized with 1g of Vancomycin. Closed-loop hemoadsorp- tion circuits were set up using two HA380 minimodules (FC and NFC) and circulations (FC with bag A and NFC with bag B) were maintained at 250 mL/min for 1h, while X and Y remained in incu- bation. 5 mL samples were drawnfrom all 4 bags at predefined time-points to measure Vancomycin concentration and injected into hemoculture to determine TTP. At the beginning (T1) and at the end (T2) of in vitro circulation, samples were taken. Then, 70mg of Vancomycin was added to bag B and 30mg to bag Y and, after 1h of incubation of all 4 bags, samples were taken (T3). Additionally, in vitro hemoadsorption with NFC and bag B were performed, while A, X and Y were placed in incubation. After 1h of treatment or incubation, samples were taken from the 4 bags (T4). Results are shown in Table 1. Conclusions. Reduction of bacterial load, with increase of TTP, after hemoadsorption with FC. Prolonged effect on TTP using FC. TTP of B were affected by NFC adsorption and Vancomycin infusions. The study demonstrated that hemoadsorption with FC has an equal effect on bacterial concentration compared to standard therapy. SEPSIS TRIESTE 2024 - 2nd Edition - Trieste, 20 e 21 settembre 2024 [Emergency Care Journal 2025; 21(s1)] [page 7] Table 1. Vancomycin concentration and TTP of the 4 bags at predefined time-point. SURGICAL SOURCE CONTROL ASSESSMENT OF ANTIBIOTIC CONCENTRATIONS IN ABDOMINAL ABSCESSES: PROTOCOL OF A PROSPEC- TIVE STUDY Manuela Mastronardi1*, Verena Zerbato2, Paola Germani3, Nicolas Zucchini1, ChiaraMenghini1, Gabriele Stocco1,4, Giuliano Ponis4, Stefano Di Bella1,2, Nicolò de Manzini1,3, Alan Biloslavo3 1Department of Medical, Surgical and Healthcare Sciences, University of Trieste; 2 Infectious Diseases Unit, Trieste University Hospital - ASUGI, Trieste; 3General Surgery, Trieste University Hospital - ASUGI, Trieste; 4Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy Presenting Author: Chiara Menghini; Email: chiara- menghini@virgilio.it Corresponding Author: Manuela Mastronardi; email: manuela.mastronardi@gmail.com Objectives. In patients presenting with abdominal abscesses, the timely administration of antibiotics is essential for preventing fur- ther complications and ensuring effective treatment. However, a significant challenge in clinical practice is determining the appro- priate type, administration method, and duration of antibiotic ther- apy. Secondly, it remains unclearwhether antibiotics can be safely discontinued once the sepsis is resolved or must be continued until the abscess is fully treated. This uncertainty underscores the need for precisemonitoring of antibiotic levels within both the blood and the abscess fluid. To address this issue, our study aims to measure and compare antibiotic concentrations in both blood and abscess fluid. The findings are expected to provide critical insights into optimizing antibiotic treatment, ultimately improving patient out- comes in the management of abdominal abscessestreatment. Design. Prospective observational study Setting. Academic Hospital Patients. Adult patients with abdominal abscesses undergoing sur- gically or radiologically drainage after at least 24 hours of antibi- otic therapy with piperacillin/tazobactam or meropenem. Interventions. None Methods and main results. The primary objective is to measure the antibiotic concentrationin both blood and abscess fluid. Patients will receive standard antibiotic therapy in continuousinfusion (18 g of piperacillina/tazobactam over 24 h, and 3 g of meropenem over 24 h). Bloodand abscess fluid samples will be obtained after 24 hours after the start of antibiotic therapy (steady-state). Secondary objectives include: 1) evaluating the differences in antibiotic con- centrations between blood and abscess fluid; 2) evaluating the above-mentioned concentrations in special populations (obese patients, those with liver disease, renal insufficiency, hypoalbu- minemia). The study will likely reveal a range of drug concentra- tions inblood and abscess fluid that correlates with effective treat- ment. In special populations (i.e. patients with obesity, liver dis- ease, renal insufficiency, hypoalbuminemia) we anticipate that altered pharmacokinetics may necessitate adjustments in antibiotic dosing to achieve therapeutic concentrations. Conclusions. This study aims to refine the understanding of antibi- otic distribution between blood and abscess fluid in patients with abdominal abscesses. By measuring and comparing drug concen- trations in these compartments, the research will contribute valu- able insights into optimizing antibiotic therapy. The findings are expected to guide clinicians in making more informed decisions regarding the choice and duration of antibiotic therapy and improving individualized patient care in the management of sepsis and abdominal abscesses. References 1. Wagner C, Sauermann R, Joukhadar C. Principles of antibiotic penetration into abscess fluid. Pharmacology. 2006;78(1):1-10. doi: 10.1159/000094668. Epub 2006 Jul 19. PMID: 16864973. 2. Sauermann R, Karch R, Langenberger H, Kettenbach J, Mayer-Helm B, Petsch M, Wagner C, Sautner T, Gattringer R, Karanikas G, Joukhadar C. Antibiotic abscess penetration: fos- fomycin levels measured in pus and simulated concentration- time profiles. Antimicrob Agents Chemother. 2005 Nov;49(11):4448-54. doi: 10.1128/AAC.49.11.4448- 4454.2005. PMID: 16251282; PMCID: PMC1280140. 3. Sauermann R, Feurstein T, Karch R, Kjellsson MC, Jäger W, Böhmdorfer M, Püspök A, Langenberger H, Wild T, Winkler S, Zeitlinger M. Abscess penetration of cefpirome: concentra- tions and simulated pharmacokinetic profiles in pus. Eur J Clin Pharmacol. 2012 Oct;68(10):1419-23. doi: 10.1007/s00228- 012-1270-1. Epub 2012 Mar 23. PMID: 22441316. Emergency Care Journal 2025; volume 21(s1) [page 8] [Emergency Care Journal 2025; 21(s1)] EARLY MICROBIOLOGICAL DIAGNOSIS A RARE CASE OF DIZZINES Carmine Nasta, Antonia Ida Facciuto, Romeo Morelli, Francesca Palumbo, Martina Finelli, Mauro Giordano U.O.C. Medicina Interna e P.S. Ospedale “A. Guerriero” Marcianise Università degli studi della Campania “Luigi Vanvitelli”, Italy Correspondence author: Carmine Nasta E-mail: carminenasta1@gmail.com Case History. Female patient, 50 years old, Ukrainian nationality, came to the emergency room for dizziness syndrome associated with weight loss of 12 kg in the last month. The anamnesis revealed worsening postural instability associated, sometimes, with dizziness and vomiting for approximately 3 months. The patient had normal vital signs and GCS15. Despite the therapy, headache and dizziness persisted, so she carried out haematochem- ical tests, results were normal, and head CT without contrast medi- um which highlighted multiple areas of tissue hypodensity sur- rounded by digitiform edema mostly located in the left cerebellar area, capsular nucleus bilaterally and left frontal cortico-subcorti- cal, referable in the first instance to repetitive injuries. Therefore, she carried out a neurosurgical consultation which indicated the need for a total body CT scan and therapy with Dexamethasone and Mannitol. On suspicion of heteroplastic pathology with sec- ondary effects, she was admitted to Internal Medicine for further investigation of the case. She performed routine blood chemistry, with findings of severe lymphocytopenia (400 u/L), sampling for oncomarkers and total body CT with contrast medium. Once lym- phocytopenia was assessed, blood tests were carried out to exclude an infectious origin of the lesions. There was positivity for HIV-Ab and IgG for Cytomegalovirus, Toxoplasma and Rubella. Having re-evaluated the CT images with the ward doctor, the residents on duty and the radiologist, given the finding of positivity to HIV Ab, the clinical suspicion of brain abscesses from Toxoplasma Gondii was advanced, for which empirical antibiotic therapy with Cotrimoxazole was started and an MRI was carried out. After infectious disease consultation he practiced prophylaxis for Mycobacterium Avium Complex. He therefore moved to the Infectious Diseases department of the Polyclinic where he began HAART therapy 10 days after the start of empirical antibiotic ther- apy, with the aim of avoiding immune reconstitution syndrome. Rachicentesis was not performed as it was contraindicated by the brain CT picture. Discussion. T. gondii is a parasite that can infect humans in vari- ous ways including ingestion of raw meat containing tissue cysts or water contaminated with cat feces. Toxoplasmosis in HIV-posi- tive patients is usually a consequence of the reactivation of the tis- sue cysts of the parasite. MRI is superior to CT in diagnosis, how- ever Imaging techniques cannot distinguish toxoplasmosis from other neurological opportunistic infections. Lumbar puncture should be performed only if safe and feasible, and CSF character- istics are usually of little significance. Therapy should be started once the probable/presumptive diagnosis has been made and the response allows diagnostic confirmation. For treatment we recom- mend pyrimethamine (PYR) which is not always available and has reduced bioavailability in a malnourished patient, resulting in a wider use of TMP/SMX as first line. Immune reconstitution syn- drome (IRIS) is uncommon in patients with cerebral toxoplasmosis and steroids remain the main therapeutic support, as they inhibit cellular destruction due to immune recovery. HAART is usually started within 2 weeks of starting treatment for cerebral toxoplas- mosis. SEPSIS TRIESTE 2024 - 2nd Edition - Trieste, 20 e 21 settembre 2024 [Emergency Care Journal 2025; 21(s1)] [page 9] Emergency Care Journal 2025; volume 21(s1) EARLY MICROBIOLOGICAL DIAGNOSIS CD169 AND HLA-DR IN BLOOD CELLS AND CIRCULA- TING EXTRACELLULAR VESICLES IN COVID-19 AS MARKERS INFECTION AND POST-ACUTE SEQUELAE MINITORING Vita Petrone1, Marialaura Fanelli1, Rossella Chirico1, Chiara Cipriani1, Martina Giudice, Luigi Coppola2, Elisabetta Teti2, Chiara Sorace2, Vincenzo Malagnino2,3, Marco Iannetta2,3, Fabrice Malergue4, Emanuela Balestrieri1, Loredana Sarmati,2,3, Sandro Grelli1,5, Antonella Minutolo1*, Claudia Matteucci1* 1Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy; 2Infectious Diseases Clinic, Policlinic of Tor Vergata, Rome, Italy; 3Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; 4Global Research Organization, Beckman Coulter Life Sciences, Marseille, France; 5Virology Unit, Policlinic of Tor Vergata, Rome, Italy Presenting author: E-mail: vita.petrone01@gmail.com *Equally contribution Objectives. An elevated inflammatory response and immune dys- regulation are the main consequences of SARS-CoV-2 infection and characterize COVID-19 disease. This dysregulated inflamma- tory state persists even after infection, generating the post-acute Figure 1. Analysis of CD169 RMFI and the percentage of HLA-DR+ and CD169+ in monocytes cells and in circulating MVs in COV, LC, and HD. A) Representation of CD169 RMFI, defined as the ratio of the mean fluorescence intensity (MFI) of CD169 in HLA-DR+ monocytes and lymphocytes, evaluated in COV (n = 133, red box), PASC (n = 132, orange box) and HD (n = 59, white box). B) impact of the SARS-CoV-2 waves in CD169 and HLA-DR modulation. C) Circulating MVs reported as % of CD169+ HLA-DR+ positive MVs and as events microliter/plasma. The Mann Whitney test was used to compare groups (***p ≤ 0.001; **p ≤ 0.01; *p ≤ 0.05). [page 10] [Emergency Care Journal 2025; 21(s1)] sequelae of SARS-CoV-2 infection in Long COVID individuals (LC). The identification of innovative biomarkers to characterized acute COVID-19 and predict its long-term effects are needed. CD169+ macrophages play an important role in viral infections helping to differentiate viral vs bacterial infection (Bourgoin P et al. 2021) and recently has been demonstrated that CD169 was strongly overexpressed in the blood of COVID-19 patients (COV) in the early stage of SARS-CoV-2 infection (Bedin et al 2021, Minutolo et al. 2021) Design and Setting. Considering the close implication of CD169 expression in COVID-19, in the present study the analysis of CD169 was extended to a large cohort of COVID-19 patients and LC individuals both at blood cells and on circulating extracellular vesicles (EVs) in association with immune dysfunction, inflamma- tory markers and clinical features. Patients. Blood samples from 133 COV, 132 LC (7-48 weeks’ post-infection), and 59 Healthy Donors (HDs) were collected at Tor Vergata University Hospital of Rome in the period May 2020 and June 2023. Ethical approval for the collection and use of human samples was obtained from the Ethics Committee of ‘Fondazione Tor Vergata’, COrona VIrus Disease: Safety and effi- cacy of experimental treatment (COVID_SEET prot.7562/2020, 9 April 2020, experimental register 46.20). Intervention. None Methods and Main Results. Flow cytometry for Leukocytes sub- sets immunophenotyping and MVs characterization was per- formed by CytoFLEXs and CytoFLEX SRT. Serum inflammatory markers were assessed by Ella immunoassay system. Biomarkers were associated with clinical and biochemical parameters. Statistical analysis far performed by SPSS 23 software. As report- ed in Figure 1, CD169 RMFI was found significantly higher in COV than in HDs, and it correlated with CD8 T-cell senescence and exhaustion markers in COV. CD169 RMFI correlated with blood cytokine mRNA levels, inflammatory markers, and pneumo- nia severity in patients who were untreated at sampling, and was associated with the respiratory outcome throughout hospitaliza- tion. We have also observed alterations of CD169 and HLA-DR expression and indices of inflammation upon different COVID-19 waves, and recently we also found the persistence of circulating CD169+HLA-DR+ monocytes in LC individuals (Fanelli et al. 2024). The analysis of CD169 and HLA-DR was extended at the level of circulating EVs in association with serum inflammatory markers and clinical features. In plasma, the percentage and num- ber of HLA-DR+CD169+ EVs were significantly elevated in COV and persisted, although at lower level, in LC compared to HDs, correlating with coagulation factors and inflammatory indices in COV and with D-dimer in LC. Our results confirmed the CD169 and myeloid activation as predictive markers of COVID-19, and the persistance of myeloid activation in LC. A dynamic correlation among CD169 and HLA-DR expression was found at cellular level and EVs in association with inflammatory cytokines and coagula- tion factors, drawing attention to EVs phenotyping for monitoring emerging respiratory viruses associated diseases. References 1. Bourgoin P. et al. CD169 and CD64 could help differentiate bacterial from COVID-19 or other viral infections in the Emergency Department. Cytometry A. 2021;99:435–445. doi: 10.1002/cyto.a.24314. 2. Bedin A.S. et al. Monocyte CD169 Expression as a Biomarker in the Early Diagnosis of Coronavirus Disease 2019. J. Infect. Dis. 2021;223:562–567. doi: 10.1093/infdis/jiaa724. 3. Minutolo A. et al. High CD169 Monocyte/Lymphocyte Ratio Reflects Immunophenotype Disruption and Oxygen Need in COVID-19 Patients. Pathogens. 2021 Dec 18;10(12):1639. doi: 10.3390/pathogens10121639. 4. Fanelli M. etal. Persistence of circulating CD169+monocytes and HLA-DR downregulation underline the immune response impairment in PASC individuals: the potential contribution of different COVID-19 pandemic waves. Curr Res Microb Sci. 2023 Dec 12;6:100215. doi: 10.1016/j.crmicr.2023.100215. SEPSIS TRIESTE 2024 - 2nd Edition - Trieste, 20 e 21 settembre 2024 [Emergency Care Journal 2025; 21(s1)] [page 11] RESUSCITATION AND MONITORING SEPTIC SHOCK AND INFECTIVE ENDOCARDITIS FROM TOXIGENIC CORYNEBACTERIUM DIPHTHERIAE Matteo Fabris1,2, Raffaele Saro1,2,*, Agnese Zanus Forte3, Tiziana Bove1,2, Carlo Tascini1,3, Monica Monaco4 1Department of Medicine (DMED), University of Udine; 2Department of Anaesthesia and Intensive Care Medicine, ASUFC, University Hospital of Udine; 3Infectious Disease Unit, University Hospital of Udine (ASU-FC), Udine; 4Istituto Superiore di Sanità, Department of Infectious, Parasitic & Immune-mediated Diseases, Rome, Italy *E-mail: raffaele.saro@outlook.it Objectives. We report the case of a patient who experienced septic shock and infective endocarditis (IE) with early septic emboli due to toxigenic Corynebacterium diphtheriae infection. The aim of this study is to describe the therapeutic strategies adopt- ed to deal with a rare infective disease which occurred with much atypical manifestations. Design. Case report. Setting. Intensive care unit (ICU). Patients. Patient admitted to ICU with ascertained C. diphtheriae infection. Interventions. None. Methods and main results. Written consent was obtained from patient prior to the publication of this report. A 57-years-old male was admitted to hospital due to persistent fever, headache and arthralgias. He referred recent business trip into foreign country but denied any raw food assumption or tick bite. Previous medical history and physical examination were otherwise unremarkable. Once haemocultures were collected, empiric antibiotic therapy was started (Table 1). Samples lately tested positive for Corynebacterium diphtheriae. The strain was thus sent to Istituto Superiore di Sanità (ISS), which not only confirmed C. diphtheriae (biotype mitis) growth, but also detected diphtheria toxin gene in vitro expression, via Elek test (Figure 1). Therapy was thus modi- fied according to antibiogram (Table 2) and diphtheria antitoxin infusion was started. Notably, otolaryngologist evaluation excluded upper airways involvement. Furthermore, oropharyngeal swabs repeatedly tested negative. Among recovery, the patient experi- enced desaturation, left hemiplegia, aphasia and lethargy. Brain computed tomography (CT) was carried out to assess the diagnosis; acute occlusion of the proximal tract of the middle right cerebral artery was identified, leading to thromboaspiration to be performed. Septic cerebral embolism diagnosis was assessed after sample cul- ture tested positive for C. diphtheriae. To optimize central nervous system penetration, antibiotic therapy was thus shifted to meropen- em. Concomitant elevation of I troponin subunit, in a patient already diagnosed with septic emboli and bacteriemia, arouse the suspect for IE; diagnosis was established due to trans-oesophageal echocardiography identification of mitral and aortic valves multiple vegetations. Given severe valves regurgitation, cardiac surgery was performed to allow valves replacement. Lately, due to the rise of liver necrosis enzymes and the rapid development of acute kidney injury, CT scans were extended to abdomen to detect any other site of embolization. Two ischemic lesion were identified in the spleen and in the left kidney whereas no pathologic areas were seen in the liver. After fifteen days of proper antibiotic therapy, there was no more clinical or microbiological detection of the pathogen. Emergency Care Journal 2025; volume 21(s1) [page 12] [Emergency Care Journal 2025; 21(s1)] Table 1. Antibiograms and therapeutic choices of the two main pathogens identified among recovery. MIC = minimal inhibiting concen- tration; S = sensitive; R = resistant; I = intermediate. SEPSIS TRIESTE 2024 - 2nd Edition - Trieste, 20 e 21 settembre 2024 Table 2. Daily resume of most important diagnostic monitoring and therapies. ABT = antibiotic therapy; CT = computed tomography; IE = infective endocarditis; AKI = acute kidney injury; NSAID = non-steroidal anti-inflammatory drugs; β-DG = beta-D-glugan; MCA = mean cerebral artery; TOE = trans-oesophageal echocardiography; TnI = I troponin subunit. Figure 1. Phenotypic, genomic and molecular analyses performed by ISS on haemocultures samples. [Emergency Care Journal 2025; 21(s1)] [page 13] Conclusions. Given an incidence of 0-0.1 cases per million peo- ple, diphtheria is considered as a rare disease in the European region [1]. The pathogen normally causes symptoms limited to oropharynx or upper airways but, following toxin diffusion and absorption, can induce systemic complications, such as myocardi- tis and neuritis [2]. Rarely, the pathogen can cause bacteraemia and endocarditis but in the majority of reported cases, non-toxigenic strains are involved [3,4]. This report describes an atypical and rare case of toxigenic C. diphtheriae infection, given lack of airways or skin impairment, septic shock, extensive cardiac valves aggression and early septic embolization. References 1. WHO. Annual WHO/UNICEF joint reporting form and WHO regional offices reports: Diphtheria reported cases. http://apps.who.int/immunization_monitoring/en/global. Accessed on 2024, July 29th. 2. Sharma NC, Efstratiou A, Mokrousov I, Mutreja A, Das B, Ramamurthy T. Diphtheria. Nat Rev Dis Primers. 2019 Dec 5;5(1):81. doi: 10.1038/s41572-019-0131-y. PMID: 31804499. 3. Mishra B, Dignan RJ, Hughes CF, Hendel N. Corynebacterium diphtheriae endocarditis--surgery for some but not all! Asian Cardiovasc Thorac Ann. 2005 Jun;13(2):119-26. doi: 10.1177/021849230501300205. PMID: 15905338. 4. Muttaiyah S, Best EJ, Freeman JT, Taylor SL, Morris AJ, Roberts SA. Corynebacterium diphtheriae endocarditis: a case series and review of the treatment approach. Int J Infect Dis. 2011 Sep;15(9):e584-8. doi: 10.1016/j.ijid.2011.04.003. Epub 2011 Jun 8. PMID: 21641260. Emergency Care Journal 2025; volume 21(s1) [page 14] [Emergency Care Journal 2025; 21(s1)] EARLY DIAGNOSIS AND TREATMENT OF ORGAN DYSFUNCTIONS MANAGEMENT OF ACUTE PYELONEPHRITIS IN THE EDOU AND IN THE REGULAR WARD Anna Vascotto,1 Marcello Candelli,2 Ilaria Balsamo,3 Alberto Manno,4 Giulia Pignataro,5 Andrea Benicchi,6Maria Lumare,7 Veronica Ojetti,8 Francesco Franceschi9 1Department of Emergency Medicine, University Cattolica del Sacro Cuore, Facoltà di Medicina, Rome, RM; 2Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS of Rome; 3Department of Emergency Medicine, University Cattolica del Sacro Cuore, Facoltà di Medicina, Rome, RM; 4Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli – IRCCS of Rome; 5Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS of Rome; 6Department of Emergency Medicine, University Cattolica del Sacro Cuore, Facoltà di Medicina, Rome, RM; 7Department of Emergency Medicine, University Cattolica del Sacro Cuore, Facoltà di Medicina, Rome, RM; 8Department of Emergency Medicine, University Cattolica del Sacro Cuore, Facoltà di Medicina, Rome; 9Department of Emergency Medicine, Fondazione Policlinico Universitario A.Gemelli –IRCCS of Rome, RM, Italy E mail: anna.vascotto01@icatt.it ; annicpan@gmail.com Contents. Pyelonephritis, according to the European Association of Urology 2023 guidelines, is suggested by fever (>38°C), chills, flank pain, nausea, vomiting, or costovertebral angle tenderness, with or without the symptoms of cystitis. While uncomplicated cases can be managed conservatively, complicated cases, including those with sepsis or persistent vomiting, require hospitalization for intravenous antibiotic therapy and proper hydration. SEPSIS TRIESTE 2024 - 2nd Edition - Trieste, 20 e 21 settembre 2024 [Emergency Care Journal 2025; 21(s1)] [page 15] Table 1. Objectives. The aim of this study is to assess whether there are differences in the treatment of pyelonephritis between hospital wards and the emergency department observation unit (EDOU), particularly in terms of length of hospital stay. Design.We decided to build a retrospective, observational study in order to evaluate whether the length of hospitalization would change. Demographic characteristics, symptoms, physical exami- nation findings, past medical history, laboratory tests, and imaging results were analyzed. Setting. From February 27, 2021, to April 19, 2023, we collected data on all patients admitted to the Gemelli Hospital emergency department with a diagnosis of pyelonephritis. Patients. We enrolled 183 patients, of whom 61 (48%) were males, with a mean age of 53 ± 19 years. 130 patients (71%) pre- sented with fever, 114 (62%) with flank pain, and 94 (51%) with urinary symptoms. Upon physical examination, a positive Giordano sign was found in 55 patients (30%). The Charlson Comorbility Index (CCI) was calculated for each patient. 78 patients had previously experienced a similar episode, and 74 were carriers of a septic focus (26 stents, 28 nephrostomies, 14 urinary catheters, 6 ureterocutaneostomies, 30 urinary lithiasis). Interventions. None Methods and main results.More than 70% of patients underwent ultrasound of the urinary tract, while just over 50% underwent abdominal CT scan with contrast. Laboratory tests revealed elevat- ed markers of infection with an increase in white blood cell count, C-reactive protein, creatinine and procalcitonin. In 108 patients (59%), a urine culture was performed, resulting positive in 70%, and in 100 (55%), a blood culture was performed, resulting posi- tive in 20%. The most frequently detected bacterium was Escherichia coli (32 patients, 36% of the total). Empirical antibiot- ic therapy, primarily piperacillin/tazobactam, was initiated in 80% of patients, with 19 patients requiring an upgrade due to multidrug resistance. Results showed that 61 (33%) patients were admitted to the EDOU, and 122 to a ward. The average length of stay in the EDOU was significantly shorter (90 ± 47 hours) compared to the ward (240 ± 197 hours). In the univariate analysis, age (p = 0.0001), history of previous surgeries on the urinary system (p = 0.004), CCI (p < 0.01), gender (p = 0.07), and discharge within 72 hours (p < 0.01) were significantly associated with admission to EDOU. In the multivariate analysis, only discharge within 72 hours after correction for the aforementioned factors was found to be independently associated with admission to EDOU (p < 0.001, OR 15.51, 95% CI 4.1–57.36). Conclusions. In conclusion, the EDOU serves a vital role in pro- viding both observation and treatment for pyelonephritis patients, with shorter hospital stays compared to traditional wards. This contributes to optimizing patient care and resource utilization in the management of acute medical conditions. References M.A. Ross, S. Compton, D. Richardson et al., Ann Emerg Med. The use and effectiveness of an emergency department obser- vation unit for elderly patients. 2003, 41(5):668-77 L.S. Svingel, C. F. Christiansen, H. Birn et al., IJID Reg. Temporal changes in incidence of hospital- diagnosed acute pyelonephri- tis: a 19-year population-based Danish cohort study, 2023, 12:9:104- 110 AL Flores-Mireles, JN Walker, M Caparon et al, Nat Rev Microbiol Urinary tract infections: epidemiology, mechanisms of infection and treatment options. 2015 May 13(5): 269-84 KSM Khoo, ZY Lim, CY Chai et al, Singapore Med J. Management of acute pyelonephritis in the emergency depart- ment observation unit. 2021 Jun; 62(6):287-295 Emergency Care Journal 2025; volume 21(s1) [page 16] [Emergency Care Journal 2025; 21(s1)]