A case–control study evaluating the unnecessary use of intravenous broad-spectrum antibiotics in presumed sepsis and septic-shock patients in the emergency department

Abstract

Objectives: Recognition of sepsis frequently occurs in emergency departments. To evaluate the appropriateness of empiric antibiotic use in the setting of suspected sepsis in emergency department, the percentages of bacterial infection and antibiotic-related adverse drug effects were quantified in an emergency department at an academic medical center. Methods: We retrospectively reviewed electronic medical records of adults who presented to the emergency department between January 2018 and June 2018 with suspected sepsis (defined as having ≥2 systemic inflammatory response syndrome [SIRS] criteria) and received ≥1 dose of intravenous broad-spectrum antibiotic. Results: In total, 218 patients were included in the final analysis. Moreover, 19.3% of these patients had confirmed bacterial infections; 44.5% had suspected bacterial infections; and 35.9% did not have bacterial infection. Elevated SIRS score (ie, ≥2) and Quick Sequential Organ Failure Assessment (qSOFA) score (ie, ≥2) were not associated with the presence of bacterial infections. We identified 90-day Clostridioides difficile infections in 7 patients and drug-resistant organism infections in 6 patients, regardless of the presence of bacterial infections. Conclusions: A high number of patients received intravenous broad-spectrum antibiotics in the emergency department without confirmed or suspected bacterial infections that were supported by microbiologic cultures, radiographic imaging, or other symptoms of infections. Most patients who were initially admitted to the emergency department with suspected sepsis were discharged home after receiving 1 dose of intravenous antibiotic. Patients who were initially screened using SIRS score and who received broad-spectrum antibiotics in the emergency department were without confirmed or suspected bacterial infection.

Validation of SeptiCyte RAPID to Discriminate Sepsis from Non-Infectious Systemic Inflammation

“…Proof of infection by the conventional ‘gold standard’ criterion of culture positivity lacks timeliness [ 10 ] and cultures are negative in a significant fraction of retrospectively diagnosed sepsis cases [ 11 , 12 ]. The presence of infection could perhaps be inferred from the clinician’s act of therapeutic antibiotic administration, but this is also problematic, as antibiotics are found in retrospect to often be overprescribed [ 13 , 14 , 15 ]. Also, in the early stages of sepsis, organ dysfunction (the sine qua non for sepsis under the Sepsis-3 definition) may not yet be highly evident or easily detected.…”

Validation of SeptiCyte RAPID to discriminate sepsis from non-infectious systemic inflammation

“…Proof of infection by the conventional ‘gold standard’ criterion of culture positivity lacks timeliness [10] and cultures are negative in a significant fraction of retrospectively diagnosed sepsis cases [11,12]. The presence of infection could perhaps be inferred from the clinician’s act of therapeutic antibiotic administration, but this is also problematic, as antibiotics are found in retrospect to often be overprescribed [13–15]. Also, in the early stages of sepsis, organ dysfunction (the sine qua non for sepsis under the Sepsis-3 definition) may not yet be highly evident or easily detected.…”