The “golden hour” is almost the only good news that can be associated with health events as serious as stroke, heart attack or sepsis. Being lucky enough to receive adequate care within the first 60 minutes multiplies survival and is also a great step toward a full recovery without sequelae. With protocols called the “stroke code” and the “heart attack code,” the idea that “the earlier the better” has been normalized in society and in healthcare for years when faced with these clinical conditions. However, Spanish microbiologists regret that the same does not happen in sepsis, the immune system’s response to a bacterial infection so virulent that it threatens the patient’s life by damaging vital organs.
“In the face of sepsis, with appropriate treatment in the golden hour, survival rates of up to 85% can be achieved. From there, the death rate increases by 8% for every 60 minutes of delay. Four hours later, survival drops to about half. And only one in eight patients will survive if it takes 12 hours to start appropriate treatment,” illustrates Andrés Canut, president of the Study Group for Management in Clinical Microbiology (GEGMIC) of the Spanish Society for Infectious Diseases and Clinical Microbiology (SEIMC). .
Five years after the pandemic, Spain is still a long way from ensuring that all major hospitals have fully functional microbiology services 24 hours a day, every day of the year, known among the profession as “24. /7”. Something that experts believe is essential to provide reliable help against sepsis, but also in many other critical processes such as meningitis.
During the month of December, SEIMC collected all the information on virtually all the largest health facilities in the country, considering as such those with more than 500 beds – tertiary teaching hospitals – and other smaller centers that are “one-of-a-kind”. those to offer help in their provinces,” said the document summarizing the work to which EL PAÍS had access.
There are a total of 85 hospitals, which divide the results of the study into three large groups. The first consists of those who “offer continuous care with the physical presence of laboratory technicians and microbiological doctors 24 hours a day, every day of the year.” This is the ideal situation that a scientific society like SEIMC believes all major centers should follow, although the data shows that only 51 (60% of the total) do so.
The second group consists of hospitals in which a microbiologist is present in the afternoon – from 3:00 p.m. to 8:00 p.m. until midnight – but not in the early morning hours. In some centers services remain open without a microbiologist and their absence is compensated by localized night shifts in which these specialists can be contacted by laboratory staff. There are 26 hospitals in this group, 31% of the total number. Finally, in another eight centers (9%), the presence of the microbiologist ends at three in the afternoon and does not return until the next morning.
“It is inefficient to have the appropriate technology in hospitals and not be able to use it due to limited working hours and without the physical presence of a microbiologist. The research we have done shows that in Spain there is still considerable room for improvement in the continuing care of these services, which are crucial in any large hospital,” complains Andrés Canut.
According to the data obtained by SEIMC – see all the data in the attached graphs – only in the Community of Valencia (six out of six hospitals), the Canary Islands (four out of four), the Balearic Islands and Cantabria (one out of one) do the microbiology services of all its major hospitals operate 24 hours a day throughout the year.
It is closely followed by Madrid with nine of the ten largest hospitals (only Getafe is left out of the group) and Andalusia (10 out of 13). Five of its largest eight hospitals are in Catalonia, four out of seven in Galicia, three out of ten in Castilla y León, two out of five in Castilla-La Mancha and one out of five in Aragon and the Basque Country. Asturias, Extremadura and Murcia have one of their two large centers without a microbiology service open with a specialist present 24 hours a day all year round, while Navarra, Rioja, Ceuta and Melilla have only one large hospital without a 24/7.
EL PAÍS asked all communities that have a large hospital without 24/7 for the reasons for this decision. One of the most frequently repeated answers is that “localized guards with laboratory technicians allow services to be kept open 24 hours a day with adequate management of available resources”.
However, according to SEIMC, “on-call localization, while a partial solution, does not guarantee 100% assistance or perform all the critical interventions required within a clinical microbiology service.” Some of the reasons are that immediate consultation with a specialist “is necessary to adjust the treatment of severe or multidrug-resistant infections,” something that “cannot be done with the same speed from a localized sentinel.”
“When analyzing urgent samples, the interpretation of preliminary results can significantly change the diagnostic and therapeutic course,” which “can only be handled immediately by the microbiological specialist present,” adds the company.
Catalonia claims that in two of its major hospitals – Joan XXIII in Tarragona and Dr. Josep Trueta in Girona, both responsible for the care of almost a million people – the afternoon and evening service is provided by an analysis specialist whose “. the specialty includes training in microbiology, hematology, and biochemistry, allowing coverage of required tests when sufficient microbiologists are not available.
Galicia, in turn, believes that the demand for care is covered by the use of “automated tests in a central laboratory” and the “physical presence of laboratory technicians”, although there is no microbiologist.
Castilla-La Mancha, on the other hand, defends that localized guards make it possible to cover current needs, even if it is sometimes necessary for a professional on the local guard to go to the hospital. “For this year 2025, there is no need for other types of coverage, neither proposed by the services themselves nor by management, because we also have to look at the efficiency and sustainability of the health system,” the spokesperson claims.
Communities such as La Rioja express themselves in similar terms, using the term “mixed guards” with a lab technician present and a microbiologist present who can be located. Other communities, such as Asturias, have decided to concentrate the night work of microbiology services in a single center – in this case Asturias Central – because it is “enough to provide services to the whole community during the night”.
In all cases, SEIMC appreciates these solutions, but considers them “partial” or “inadequate” at the present time and after the experience of the pandemic. “Automated tests are useful for certain routine analyses, but clinical microbiology is much more than just sample processing. And sometimes, such as cases of sepsis or meningitis, therapeutic decisions and interpretation of preliminary results cannot wait for the microbiologist to arrive on the next shift,” the company says.
Federico García, head of the specialized service at San Cecilio Hospital (Granada), is president of SEIMC. “The healthcare system cannot forget that modern medicine is precision medicine. It follows that diagnosis and treatment must be accurate and individualized, and this requires the early identification of the bacterium, virus, fungus or parasite causing the infection and the adaptation of the most specific antimicrobial drug from the first moment,” he defends.
The scientific society remembers that “the development of infection is unpredictable” and that of all patients who go to the emergency room, “10.4% are diagnosed with an infectious process”, of which one in five will require hospital admission. adoption. “In the ICU, 30-40% of patients admitted with sepsis come from the emergency services,” they remind SEIMC.
Federico García focuses on the increase in survival that 24/7 services “achieve in the face of processes such as sepsis or bacterial meningitis”, but insists that the “achieved improvements in care” go much further. “By accurately identifying the microorganism that causes the infection, we can also check its sensitivity to antibiotics or other indicated drugs, rule out the existence of resistance mechanisms and select the most suitable antimicrobial agent. In this way, it is possible to optimize the effectiveness of the treatment, minimize side effects and the possibility of resistance. All of this ultimately has an impact on better care and greater survival,” he concludes.
