Faculty Opinions recommendation of Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol.

Abstract Culture results in patients with septic shock affect their management strategies. Our study aimed to compare the clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS). A single-center, retrospective, case-control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into CNSS and CPSS groups based on their culture results. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), intensive care unit care (51.8% vs. 45.2%, p = 0.16), 30-day (35.7% vs. 36.7%, p = 0.82) and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The duration (13 [8−19] vs. 16 [10−23], days, p = 0.04) and de-escalation timing (5 [2−10] vs. 9 [7−12], day, p = 0.02) of antibiotic administration in the CNSS group was significantly shorter and earlier than in the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and adverse outcome proportions. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in CNSS patients with clinical improvement.

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63: The Effect of Time to Antibiotic Administration on Mortality in Patients Presenting to the Emergency Department in Septic Shock

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2007.06.094 ◽

2007 ◽

Vol 50 (3) ◽

pp. S21

Author(s):

R.S. Engineer ◽

D. Duncan

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Antibiotic Administration

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A multifaceted educational intervention shortened time to antibiotic administration in children with severe sepsis and septic shock: ABISS Edusepsis pediatric study

Intensive Care Medicine ◽

10.1007/s00134-017-4721-4 ◽

2017 ◽

Vol 43 (12) ◽

pp. 1916-1918 ◽

Cited By ~ 6

Author(s):

Elisabeth Esteban ◽

Sylvia Belda ◽

Patricia García-Soler ◽

Antonio Rodríguez-Núñez ◽

Cristina Calvo ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Educational Intervention ◽

Antibiotic Administration ◽

Pediatric Study ◽

Sepsis And Septic Shock

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The Use of an Early Alert System to Improve Compliance with Sepsis Bundles and to Assess Impact on Mortality

Critical Care Research and Practice ◽

10.1155/2012/980369 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 9

Author(s):

Jennifer Anne LaRosa ◽

Noeen Ahmad ◽

Monica Feinberg ◽

Monica Shah ◽

Roseann DiBrienza ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Screening Tool ◽

Severity Of Illness ◽

Antibiotic Administration ◽

Alert System ◽

Sepsis Management ◽

Sepsis Bundles ◽

Improve Compliance ◽

Early Alert

Introduction. Diagnostic and therapeutic guidelines, organized as sepsis bundles, have been shown to improve mortality, but timely and consistent implementation of these can be challenging. Our study examined the use of a screening tool and an early alert system to improve bundle compliance and mortality.Methods. A screening tool was used to identify patients with severe sepsis or septic shock and an overhead alert system known as Code SMART (Sepsis Management Alert Response Team) was activated at the physician’s discretion. Data was collected for 6 months and compliance with bundle completion and mortality were compared between the Code SMART and non-Code SMART groups.Results.Fifty eight patients were enrolled −34 Code SMART and 24 non-Code SMART. The Code SMART group achieved greater compliance with timely antibiotic administration (P<0.001), lactate draw (P<0.001), and steroid use (P=0.02). Raw survival and survival adjusted for age, leucopenia, and severity of illness scores, were greater in the Code SMART group (P<0.05,P=0.03, andP=0.01).Conclusions. A screening tool and an alert system can improve compliance with sepsis bundle elements and improve survival from severe sepsis and septic shock.

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Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study

Acute Medicine Journal ◽

10.52964/amja.0632 ◽

2016 ◽

Vol 15 (4) ◽

pp. 168-175

Author(s):

Nadia Alam ◽

◽

Kirtiedevi BNS Doerga ◽

Tahira Hussain ◽

Sadia Hussain ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Hospital Setting ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Antibiotic Administration ◽

Care Chain ◽

Discharge Letter ◽

Study Population ◽

Sepsis And Septic Shock

Introduction: General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis in the pre-hospital setting and patient outcomes. Methods Design: prospective, observational study during a 12 week period in the emergency department (ED) of two academic hospitals. Study population: Patients >18 years presenting with sepsis at the ED. The information available in the ED discharge letter and the ED charts was used to make a definite diagnosis of sepsis, severe sepsis and septic shock Outcome measures: primary: recognition/documentation of sepsis. Secondary: ED arrival time to antibiotic administration, in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) admission. Results: A total of 301 patients were included in the study. GPs and EMS personnel correctly identified and documented 31.6% (n=114) and 41.4% of all sepsis patients (n=140) respectively. Recognition and documentation of sepsis improved with increasing severity. The mean time to administration of antibiotics (TTA) was nearly halved for the group of patients where sepsis was documented (GP: 66,4 minutes, EMS: 65,6 minutes) compared to the group in which sepsis was not documented (GP: 123,9 minutes, EMS: 101,5 minutes; p= 0.365 and p= 0.024 respectively). Conclusions: There is room for improvement in the recognition of sepsis, severe sepsis and septic shock by practitioners working in the pre-hospital setting. Documentation of sepsis prior to arrival in hospital led to a reduced time delay in administration of antibiotics.

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Prognostic Values of The Timing of Antibiotic Administration and The Sepsis Bundle Component in Elderly Patients With Septic Shock

Shock ◽

10.1097/shk.0000000000001854 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Chih-Yu Liang ◽

Yong-Ye Yang ◽

Chi-Chieh Hung ◽

Tsung-Han Wang ◽

Yin-Chou Hsu

Keyword(s):

Septic Shock ◽

Elderly Patients ◽

Antibiotic Administration ◽

Sepsis Bundle

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Impact of coexisting pneumonia in the patients admitted with Clostridium difficile infection: a retrospective study from a national inpatient database

Journal of Investigative Medicine ◽

10.1136/jim-2021-001820 ◽

2021 ◽

pp. jim-2021-001820

Author(s):

Asim Kichloo ◽

Zain El-Amir ◽

Dushyant Singh Dahiya ◽

Jagmeet Singh ◽

Dhanshree Solanki ◽

...

Keyword(s):

Septic Shock ◽

Renal Failure ◽

Acute Renal Failure ◽

Clostridium Difficile ◽

Hospital Mortality ◽

Antibiotic Use ◽

Hospital Charges ◽

Inpatient Setting ◽

Antibiotic Administration ◽

The Impact

Clostridium difficile is a gram-positive anaerobic spore forming bacillus that can cause infection in a setting of antibiotic use. Pneumonia is a major cause of morbidity and mortality in an inpatient setting and is frequently associated with significant antibiotic administration. This study aims to compare the outcomes of C. difficile infection (CDI) with and without pneumonia to determine the impact of pneumonia in hospitalized patients with CDI. This population-based retrospective observational propensity matched analysis study uses data from the National Inpatient Sample database for the years 2016 and 2017. The primary outcomes were in-hospital mortality, total hospital charges, and mean length of stay. Secondary outcomes were the rates of sepsis, septic shock, non-ST elevation myocardial infarction (NSTEMI), acute renal failure, deep vein thrombosis, and pulmonary embolism. In-hospital mortality was noted to be higher in patients with pneumonia than those without (6.5% vs 1.2%, adjusted OR (aOR) 3.85; 95% CI 2.90 to 5.11, p<0.001). The following outcomes were more prevalent in patients with pneumonia compared with those without pneumonia: sepsis (9.8% vs 1.8%, aOR 4.69, 95% CI 3.73 to 5.87, p<0.001), septic shock (4.0% vs 0.5%, aOR 6.32, 95% CI 4.43 to 9.03, p<0.001), NSTEMI (1.9% vs 0.5%, aOR 2.95, 95% CI 1.85 to 4.71, p<0.001), and acute renal failure (31.5% vs 23.1%, aOR 1.23, 95% CI 1.07 to 1.40, p=0.003). In conclusion, patients with pneumonia were associated with significantly higher rates of system-based complications and higher in-hospital mortality rates.

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