Factors Associated With the Rate of Sepsis After Surgery

Background Sepsis is a critical illness that requires early detection and intervention to prevent disability and/or death. Objective To analyze the association between various hospital-related factors and rates of sepsis after surgery in Massachusetts hospitals. Methods The sample consisted of 53 hospitals with intensive or critical care units and 25 hospitals with step-down units. Hospital characteristics, staffing levels, and health care–acquired conditions were examined using publicly available data. Analysis of variance and linear regression were performed to explore the relationship between nurse and physician staffing levels and sepsis rates. Results Sepsis rates were significantly lower when nurses cared for fewer patients (P < .001) and when intensivist hours were greater (P = .03). Linear regression for nurse staffing revealed that higher rates of catheter-associated urinary tract infection (P = .001) and higher numbers of step-down patients cared for by nurses (P = .001) were associated with a significantly higher rate of sepsis (P < .001). Linear regression for physician staffing revealed that higher rates of catheter-associated urinary tract infection (P < .001) and wound dehiscence after surgery (P < .001), greater hospitalist hours (P = .001), and greater physician hours (P = .05) were associated with a significantly higher sepsis rate, while greater intensivist hours were associated with a lower sepsis rate (P = .002). Conclusion In this study, greater nurse staffing and intensivist hours were associated with significantly lower rates of sepsis, whereas greater physician staffing and hospitalist hours were associated with significantly higher rates. Further research is needed to understand the roles of the various types of providers and the reasons for their differing effects on sepsis rates.

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Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients

Journal of Korean Academy of Nursing ◽

10.4040/jkan.2012.42.5.719 ◽

2012 ◽

Vol 42 (5) ◽

pp. 719 ◽

Cited By ~ 17

Author(s):

Yunmi Kim ◽

Sung-Hyun Cho ◽

Kyung Ja June ◽

Soon Ae Shin ◽

Jiyun Kim

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Hospital Mortality ◽

Nurse Staffing ◽

Surgical Patients ◽

Hospital Nurse

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Impact of reflex fosfomycin susceptibility testing on the utilization of carbapenems for definitive extended-spectrum β-lactamase Escherichia coli urinary tract infection treatment

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa174 ◽

2020 ◽

Vol 77 (Supplement_4) ◽

pp. S105-S110

Author(s):

Kevin Deemer ◽

Jonathan Grey ◽

Christopher Fronczek ◽

Kerry Marr

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Definitive Treatment ◽

E Coli ◽

Extended Spectrum ◽

Oral Agents ◽

Days Of Therapy ◽

Step Down

Abstract Purpose A protocol was started within a large health system to automatically test all confirmed extended-spectrum beta-lactamase (ESBL)–producing Escherichia coli urine isolates for susceptibility to fosfomycin, an antibiotic not routinely included in such testing in most institutions. This study assessed the effectiveness of the protocol at reducing carbapenem use for the definitive treatment of ESBL E. coli urinary tract infection (UTI) through several endpoints. Methods Eighty and 99 patients were compared pre- and postintervention, respectively. The primary outcome was the proportion of patients who received definitive carbapenem therapy. Key secondary outcomes included median total carbapenem days of therapy (DOT), discharge on intravenous UTI antibiotics, and median total antibiotic DOT. Results Preprotocol vs postprotocol definitive carbapenem use was seen in 59 of 80 patients (73.8%) and 71 of 99 patients (71.7%) (95% confidence interval [CI] for difference, -11.1% to 15.1%; P = 0.76). The rates of step-down to oral agents pre- and postintervention were 15 of 59 (25.4%) and 35 of 71 (49.3%) (P = 0.004). Median carbapenem DOT in those receiving carbapenems decreased from 8 to 4 days (95% CI, -5 to -1 days; P = 0.001). Median total DOT decreased from 10 to 8 days (95% CI, -3 to -1 days; P = 0.002). Conclusion Implementation of a laboratory policy to automatically test ESBL positive E. coli for fosfomycin susceptibility did not reduce the percentage of patients receiving at least 1 dose of carbapenem treatment. It did result in a larger percentage reduction in step-down use of intravenous antibiotics for UTI prior to discharge, reduction in carbapenem DOT, and reduction in total antibiotic DOT.

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