Medical Infectious Diseases Among Adult Patients in the Emergency Department of HML: Incidence, Clinical Profile, and Management.

Abstract

Abstract: Objective: To determine the incidence, clinical profile, and initial management of strictly medical infectious diseases (IDs) among adult patients presenting to the ED of Colonel Lotfi Hospital, Laghouat, Algeria. Methods: A prospective observational study was conducted from November 1st, 2025, to April 1st, 2026. All adult patients (age ≥18 years) with suspected or confirmed medical IDs were enrolled via a standardized case report form. Severity was assessed using qSOFA, NEWS2, and CRB-65 (pneumonia) scores. Descriptive statistics were performed using IBM SPSS v27. Results: Of 18,206 adult ED admissions, 58 patients met inclusion criteria (incidence: 0.32%; 95% CI: 0.24–0.41%) across 17 distinct infectious entities. Lower respiratory tract infections predominated (31.0%), with pneumonia as the leading diagnosis (24.1%). Systemic infections, sepsis (5.2%), septic shock (6.9%), brucellosis (5.2%), and measles (6.9%) collectively accounted for 24.1%. Median age was 53 years (IQR: 34.75–71); diabetes mellitus was the most prevalent comorbidity (20.7%). Abnormal vital signs were present in 67.2% of patients, and 18.5% had qSOFA ≥ 2. Diagnosis was established clinically in 48.3%, radiologically in 32.8%, and microbiologically in 19.0%, with a culture positivity rate of 6.9%. Empirical antibiotics were initiated in 91.4%; guideline concordance ranged from 0% in pleuritis and cystitis to 100% in meningitis and pyelonephritis, with community-acquired pneumonia (CAP) showing the lowest concordance (7.1%). In-ED mortality was 8.6%, and 58.6% of patients required hospitalization. Conclusion: This study established the first incidence estimate of strictly medical IDs in an Algerian ED. The high mortality, broad guideline deviations, and complexity of presentations highlight critical gaps in microbiological capacity, antimicrobial stewardship, and severity-guided triage and raise a compelling case for the creation of a dedicated ID emergency unit at HML as a meaningful step toward evidence-based management in resource-limited settings.