Impact of 1-hour and 3-hour sepsis time bundles on patient outcomes and antimicrobial use: A before and after cohort study

Abstract

Summary Background Sepsis bundles, promulgated by Surviving Sepsis Campaign have not been widely adopted because of variability in sepsis identification strategies, implementation challenges, concerns about excess antimicrobial use, and limited evidence of benefit. Methods A 1-hour septic shock and a 3-hour sepsis bundle were implemented using a Breakthrough Series Collaborative in 14 public hospitals in Queensland, Australia. A before (baseline) and after (post-intervention) study evaluated its impact on outcomes and antimicrobial prescription in patients with confirmed bacteremia and sepsis. Findings Between 01 July 2017 to 31 March 2020, of 6976 adults presenting to the Emergency Departments and had a blood culture taken, 1802 patients (732 baseline, 1070 post-intervention) met inclusion criteria. Time to antibiotics in 1-hour 73.7% vs 85.1% (OR 1.9 [95%CI 1.1-3.6]) and the 3-hour bundle compliance (48.2% to 63.3%, OR 1.7, [95%CI 1.4 to 2.1]) improved post-intervention, accompanied by a significant reduction in Intensive Care Unit (ICU) admission rates (26.5% vs 17.5% (OR 0.5, [95%CI 0.4 to 0.7]). There were no significant differences in-hospital and 30-day post discharge mortality between the two phases. In a post-hoc analysis of the post-intervention phase, sepsis pathway compliance was associated with lower in-hospital mortality (9.7% vs 14.9%, OR 0.6, 95%CI 0.4 to 0.8). The proportions of appropriate antimicrobial prescription at baseline and post-intervention respectively were 55.4% vs 64.1%, (OR 1.4 [95%CI 0.9 to 2.1]). Interpretation Implementing 1-hour and 3-hour sepsis bundles for patients presenting with bacteremia resulted in improved bundle compliance and a reduced need for ICU admission without adversely influencing antimicrobial prescription.

Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia

“…21 Briefly, the Queensland Sepsis Collaborative is an statewide quality improvement programme, with the aim to improve the recognition, treatment and outcomes of patients with sepsis in Queensland. 22 A dedicated paediatric sepsis pathway was designed in iterative multidisciplinary workshops incorporating evidence and information from published or online available paediatric sepsis tools. 1 23 24 The pathway consisted of a screening tool, a management tool and antimicrobial stewardship guidance.…”

Early Sepsis Recognition in Pediatrics: A Literature Review

“…Despite the lack of prospective pediatric sepsis research and ongoing issues with diagnostic criteria, it has been shown that early recognition and provision of medication (within one hour) are the most crucial aspects of sepsis management [6][7][8][9]25]. While timely diagnosis is essential, it can be challenging.…”

“…In fact, sepsis has a tendency to cause conditions to quickly change to life-threatening conditions [6]. In spite of this, early diagnosis and implementation of current treatment guidelines have been found to enhance patient outcomes [7][8][9]. On the other hand, there is a relatively low level of compliance with treatment guidelines at the moment, and it has been shown that enhanced care and outcomes can be achieved only through the implementation of protocols [8].…”

Epidemiology, management, and outcome of infection, sepsis, and septic shock in a German emergency department (EpiSEP study)

“…The recognition, diagnosis, and initial treatment of patients with infections, sepsis, and septic shock represent a challenge for all involved in medical care that should not be underestimated (4,5). For this reason, there are international and national recommendations for the management of sepsis (6)(7)(8).…”