Blood Culture Results and Overtreatment Associated With the Use of a 1-Hour Sepsis Bundle

Zitek, Tony; Bourne, Mitchell; Raber, Joshua; Shir, Adam; Ryabtsev, Boris

doi:10.1016/j.jemermed.2020.06.055

Cited by 10 publications

(3 citation statements)

References 21 publications

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“…When the patient has an abnormal temperature (>38.0 or <36.0 °C) or is clearly displaying shivering, multiple sets of blood cultures should be collected as rapidly as possible. 24 Multiple blood culture sampling was identified as a significant negative factor for 30-day mortality (OR, 0.42). Performing it before antimicrobial treatment is reportedly a major prognostic factor in patients with sepsis.…”

Section: Discussionmentioning

confidence: 99%

Multiple Blood Culture Sampling, Proper Antimicrobial Choice, and Adequate Dose in Definitive Therapy Supported by the Antimicrobial Stewardship Team Could Decrease 30-Day Sepsis Mortality Rates

Saito,

Tsuchiya,

Itoga

et al. 2024

IDR

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This study aimed to identify factors that should be focused on by the antimicrobial stewardship team for treating patients with sepsis, by investigating the mortality of patients with sepsis within 30 days and the mortality-related factors in our hospital over a 10-year period from the perspective of appropriate antimicrobial use. Methods: Factors associated with 30-day mortality were investigated using hierarchical multiple logistic regression in 1406 patients with pathogen-identified sepsis in Hirosaki University Hospital. These factors were clinical data, microbiological data, antimicrobials used in empiric and definitive therapies, presence/absence of ineffective use, underdosing as evaluated using Monte Carlo simulation, and practice of de-escalation. Results: The ineffective use of antimicrobials in empiric therapy and the underdosing and ineffective use in definitive therapy were significantly associated with 30-day mortality (odds ratio [OR] = 2. 70, 3.72, and 3.65, respectively). Multiple blood culture sampling was inversely associated with these inappropriate antimicrobial uses. Every year, the 30-day mortality rate has been decreasing, in line with the increase in multiple blood culture sampling and de-escalation; the inappropriate use of antimicrobials has also decreased. Conclusion: Multiple blood culture sampling, proper choice of antimicrobial, and using an adequate dose in definitive therapy could decrease the 30-day mortality rate in patients with sepsis and these factors could be supported by the antimicrobial stewardship team.

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Section: Discussionmentioning

confidence: 99%

Multiple Blood Culture Sampling, Proper Antimicrobial Choice, and Adequate Dose in Definitive Therapy Supported by the Antimicrobial Stewardship Team Could Decrease 30-Day Sepsis Mortality Rates

Saito,

Tsuchiya,

Itoga

et al. 2024

IDR

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“…The continuous updating of sepsis management guidelines, from the initial 6 h-bundle to 3 h-bundle, emphasizes the importance of early intervention and treatment [9][10] . Therefore, compared with the observation point of 24h after CLP in most studies, we selected a relatively early observation point of 12h after CLP to simulate clinical sepsis, so as to provide a theoretical basis for early identification and rescue of clinical septic patients.…”

Section: Discussionmentioning

confidence: 99%

Ziqi Dihuang decoction ameliorates thrombosis in septic rats by inhitbiting plasminogen activator inhibitor-1

Geng

2023

Preprint

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Background and Aim: Sepsis is now a global medical burden with high morbility and mortality. The focus of this study was to observe and elaborate the effect of Ziqi Dihuang (ZQDH) decoction on inflammatory and thrombosis-related parameters in septic rats. Experimental procedure: A rat model of sepsis was established by cecal ligation and puncture (CLP). 24 male Sprague-Dawley (SD) rats were randomly divided into Sham group, CLP group, ZQDH-1ow group (0.735g/kg) and ZQDH-high group (1.47g/kg). Rats in ZQDH groups were given ZQDH decoction by gavage for 7 days before CLP, while rats in Sham and CLP groups were given the same amount of normal saline. Leukocytes and percentage of neutrophils (N %) in blood, and inflammatory cell infiltration of liver, kidney and lung were used to assess systemic inflammatory response. Coagulation and fibrinolytic indexes included platelet count, coagulation function, fibrin deposition, and levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) in serum, liver, kidney and lung. Results: ZQDH decoctioninhibited N% growth in blood and inflammatory cell infiltration in the lung of CLP rats. Moreover, ZQDH decoctionalso ameliorated thrombocytopenia and prothrombin time, alleviated renal fibrin deposition, and improved tPA and PAI-1 levels in kidney. Conclusion: These results suggest that ZQDH decoction can dose-dependently relieve systemic inflammatory injury and regulate coagulation-fibrinolysis system in septic rats, which may be mediated by PAI-1.

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“…To emphasize the emergent nature of sepsis management, the Surviving Sepsis Campaign published the Hour-1 bundle comprising lactate measurement, blood cultures, appropriate antimicrobials, resuscitation with volume, and use of vasopressors to initiate resuscitation within 1 h [ 5 ]. However, there are concerns that use of the Hour-1 bundle will lead to substantial overtreatment [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical effects of bacteremia in sepsis patients with community-acquired pneumonia

Kim,

Lee,

Park

et al. 2023

BMC Infect Dis

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Background Data regarding the clinical effects of bacteremia on severe community-acquired pneumonia (CAP) are limited. Thus, we investigated clinical characteristics and outcomes of severe CAP patients with bacteremia compared with those of subjects without bacteremia. In addition, we evaluated clinical factors associated with bacteremia at the time of sepsis awareness. Methods We enrolled sepsis patients diagnosed with CAP at emergency departments (EDs) from an ongoing nationwide multicenter observational registry, the Korean Sepsis Alliance, between September 2019 and December 2020. For evaluation of clinical factors associated with bacteremia, we divided eligible patients into bacteremia and non-bacteremia groups, and logistic regression analysis was performed using the clinical characteristics at the time of sepsis awareness. Result During the study period, 1,510 (47.9%) sepsis patients were caused by CAP, and bacteremia was identified in 212 (14.0%) patients. Septic shock occurred more frequently in the bacteremia group than in the non-bacteremia group (27.4% vs. 14.8%; p < 0.001). In multivariable analysis, hematologic malignancies and septic shock were associated with an increased risk of bacteremia. However, chronic lung disease was associated with a decreased risk of bacteremia. Hospital mortality was significantly higher in the bacteremia group than in the non-bacteremia group (27.3% vs. 40.6%, p < 0.001). The most prevalent pathogen in blood culture was Klebsiella pneumoniae followed by Escherichia coli in gram-negative pathogens. Conclusion The incidence of bacteremia in severe CAP was low at 14.0%, but the occurrence of bacteremia was associated with increased hospital mortality. In severe CAP, hematologic malignancies and septic shock were associated with an increased risk of bacteremia.

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Blood Culture Results and Overtreatment Associated With the Use of a 1-Hour Sepsis Bundle

Cited by 10 publications

References 21 publications

Multiple Blood Culture Sampling, Proper Antimicrobial Choice, and Adequate Dose in Definitive Therapy Supported by the Antimicrobial Stewardship Team Could Decrease 30-Day Sepsis Mortality Rates

Multiple Blood Culture Sampling, Proper Antimicrobial Choice, and Adequate Dose in Definitive Therapy Supported by the Antimicrobial Stewardship Team Could Decrease 30-Day Sepsis Mortality Rates

Ziqi Dihuang decoction ameliorates thrombosis in septic rats by inhitbiting plasminogen activator inhibitor-1

Clinical effects of bacteremia in sepsis patients with community-acquired pneumonia

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