Effects of antibiotic administration delay and inadequacy upon the survival of septic shock patients

Cañas, B. Suberviola; Jáuregui, R.; Ballesteros, M.Á.; Leizaola, O.; González-Castro, A.; Castellanos-Ortega, Álvaro

doi:10.1016/j.medine.2014.12.001

Cited by 8 publications

(11 citation statements)

References 34 publications

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“…Kumar et al reported that inappropriate empiric antimicrobial therapy was associated with a 5-fold reduction in survival (from 55% to about 11%), in over 5,000 patients with septic shock (12). In a prospective study of patients with septic shock and high severity scores, with an average of three dysfunctional organs, Suberviola Cañas et al found that patients who received inadequate antibiotics had significantly higher mortality rates compared with the patients who received appropriate treatment (33.8% vs. 51.2%; P=0.03) (74). In an interesting retrospective analysis of 2,594 patients, Vazquez-Guillamet et al found that the number needed to treat with appropriate antimicrobial therapy to prevent one patient death was 4.…”

Section: Appropriateness Of Empiric Antimicrobial Therapymentioning

confidence: 99%

“…The prescription of an empiric antibiotic treatment targeting the most probable pathogens involved is an essential step to improve patient outcomes. There is a broad literature on the detrimental impact and adverse outcomes of inappropriate empiric therapy in sepsis (11,18,35,69,(73)(74)(75)(76). Therefore, the 2016 SSC guidelines recommend that the initial treatment should include a broad-spectrum antibiotic (alone or in combination) that has activity against all likely pathogens (7).…”

Section: Appropriateness Of Empiric Antimicrobial Therapymentioning

confidence: 99%

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An approach to antibiotic treatment in patients with sepsis

Martínez¹,

Plata-Menchaca²,

Ruiz‐Rodríguez³

et al. 2020

J Thorac Dis

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Sepsis is a medical emergency and life-threatening condition due to a dysregulated host response to infection, which is time-dependent and associated with unacceptably high mortality. Thus, when treating suspicious or confirmed cases of sepsis, clinicians must initiate broad-spectrum antimicrobials within the first hour of diagnosis. Optimizing antibiotic use is essential to ensure successful outcomes and to reduce adverse antibiotic effects, as well as preventing drug resistance. All likely pathogens involved should be considered to provide an appropriate antibiotic coverage. Clinicians must investigate on the previous risk of multidrug-resistant (MDR) pathogens, and the principle of individualized dosing should replace the principle of standard dosing. The loading dose is an initial higher dose of an antibiotic for all patients, yet an individualized treatment approach for further doses should be implemented according to pharmacokinetics (PK)/pharmacodynamics (PD) and the presence of renal/liver dysfunction. Extended or continuous infusion of beta-lactams and therapeutic drug monitoring (TDM) can help to achieve therapeutic levels of antimicrobials. Reevaluation of duration and appropriateness of treatment at regular intervals are also necessary. De-escalation and shortened courses of antimicrobials must be considered for most patients, except in some justified circumstances. Leadership, teamwork, antimicrobial stewardship (AS) frameworks, guideline's recommendations on the optimal duration of treatments, de-escalation, and novel diagnostic stewardship approaches will help us to improve patients' quality of care.

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Section: Appropriateness Of Empiric Antimicrobial Therapymentioning

confidence: 99%

Section: Appropriateness Of Empiric Antimicrobial Therapymentioning

confidence: 99%

An approach to antibiotic treatment in patients with sepsis

Martínez¹,

Plata-Menchaca²,

Ruiz‐Rodríguez³

et al. 2020

J Thorac Dis

View full text Add to dashboard Cite

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“…In 68.6% of studies (n=24) [4,6,14,16,[19][20][21][22][23][24][25][26][27][28][29][30][31], the time at which antibiotics were administered was associated with in-hospital mortality, 14.2% (n=5) [29,[32][33][34][35] reported death at other times, and 2.8% (n=1) [17] studies demonstrated mortality associated with hospital or ICU length of stay. In 40% (n=14) of the included studies, a wide variety of time cutoffs (Table 1) were associated with the participants' outcome, whereas in 23% (n=8) of the studies, an hourly time interval up to 24 hours was associated with the participants' outcome.…”

Section: Cause-and-effect Relationship Between Antibiotic Administrat...mentioning

confidence: 99%

“…Ten studies [14,15,21,25,27,29,[36][37][38][39] used the moment of ED admission as their starting point; four of these studies [21,25,[27][28][29] discovered a correlation between time cutoffs and patient outcome in multivariate analyses. In nine studies [4,13,20,22,31,32,35,40,41], the onset of symptoms or signs of sepsis was designated as the starting period, and in five of these studies [4,20,22,[31][32][33][34][35], the multivariable analysis revealed a correlation between death and specific time cutoffs.…”

Section: Cause-and-effect Relationship Between Antibiotic Administrat...mentioning

confidence: 99%

Systematic Review on the Effects of Prompt Antibiotic Treatment on Survival in Septic Shock and Sepsis Patients in Different Hospital Settings

Al-Kader¹,

Anwar²,

Hussaini³

et al. 2022

Cureus

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This study aims to determine the impact of prompt administration of antibiotics in evaluating the prognosis of patients with septic shock or sepsis. On January 1, 2022, we searched the Cochrane Library, EMBASE, and MEDLINE databases for English-language articles regarding when antibiotics should be administered to patients with septic shock or sepsis. These articles were required to be published between 2010 and 2021. The primary objective was sudden or expected death from any cause at a specified time. In the study, 154,330 patients from 35 sepsis trials were included. In 19 trials, the effectiveness of antibiotics administered to 20,062 patients was evaluated. Of those, 16,652 received the correct medications. In 24 studies, the length of time it took to administer antibiotics was associated with an increased mortality rate. In fourteen studies, the time limits associated with patient outcomes ranged from 1 to 125 minutes to three to six hours. In eight studies, there were hourly delays, and in two, the time it took to receive an antibiotic played a role. Separately analyzed, the outcomes for septic shock (12,756 patients in 11 trials) and sepsis (24,282 patients in six studies) were identical. Two-thirds of sepsis studies discovered a correlation between early antibiotic treatment and the patient's prognosis. However, antimicrobial timing metrics varied significantly between studies, and there were no clear time limits.

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“…This recommendation is supported by a secondary analysis of the Edusepsis study, which showed that early administration of broad-spectrum empirical antibiotics was the component of the SSC bundles most strongly associated with increased survival [ 11 ]. Several studies have identified worse outcomes associated with delays in administering appropriate antibiotic treatment [ 1 , 2 , 12 – 15 ] and with inappropriate antibiotic therapy [ 12 , 13 , 16 ]. The SSC guidelines also recommend reassessing antibiotic treatment to determine whether de-escalation is possible, and failure to de-escalate might be associated with worse outcomes [ 8 , 16 , 17 ] and could lead to development of resistant microbes [ 8 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study

et al. 2018

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BackgroundEarly appropriate antibiotic treatment is essential in sepsis. We aimed to evaluate the impact of a multifaceted educational intervention to improve antibiotic treatment. We hypothesized that the intervention would hasten and improve the appropriateness of empirical antibiotic administration, favor de-escalation, and decrease mortality.MethodsWe prospectively studied all consecutive patients with sepsis/septic shock admitted to 72 intensive care units (ICUs) throughout Spain in two 4-month periods (before and immediately after the 3-month intervention). We compared process-of-care variables (resuscitation bundle and time-to-initiation, appropriateness, and de-escalation of empirical antibiotic treatment) and outcome variables between the two cohorts. The primary outcome was hospital mortality. We analyzed the intervention’s long-term impact in a subset of 50 ICUs.ResultsWe included 2628 patients (age 64.1 ± 15.2 years; men 64.0%; Acute Physiology and Chronic Health Evaluation (APACHE) II, 22.0 ± 8.1): 1352 in the preintervention cohort and 1276 in the postintervention cohort. In the postintervention cohort, the mean (SD) time from sepsis onset to empirical antibiotic therapy was lower (2.0 (2.7) vs. 2.5 (3.6) h; p = 0.002), the proportion of inappropriate empirical treatments was lower (6.5% vs. 8.9%; p = 0.024), and the proportion of patients in whom antibiotic treatment was de-escalated was higher (20.1% vs. 16.3%; p = 0.004); the expected reduction in mortality did not reach statistical significance (29.4% in the postintervention cohort vs. 30.5% in the preintervention cohort; p = 0.544). Gains observed after the intervention were maintained in the long-term follow-up period.ConclusionsDespite advances in sepsis treatment, educational interventions can still improve the delivery of care; further improvements might also improve outcomes.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2091-0) contains supplementary material, which is available to authorized users.

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Effects of antibiotic administration delay and inadequacy upon the survival of septic shock patients

Cited by 8 publications

References 34 publications

An approach to antibiotic treatment in patients with sepsis

An approach to antibiotic treatment in patients with sepsis

Systematic Review on the Effects of Prompt Antibiotic Treatment on Survival in Septic Shock and Sepsis Patients in Different Hospital Settings

Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study

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