Impact of an Antibiotic-specific Sepsis Bundle on Appropriate and Timely Antibiotic Administration for Severe Sepsis in the Emergency Department

Kalich, Bethany A.; Maguire, Jane; Campbell-Bright, Stacy; Mehrotra, Abhi; Caffey, Tom; Tulu, Zeynep; Lin, Feng; Carson, Shannon S.

doi:10.1016/j.jemermed.2015.09.007

Cited by 20 publications

(8 citation statements)

References 25 publications

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“…Although the blood is considered sterile in physiological state, it may harbor dormant microbes, or microbes can enter the bloodstream due to translocation or pathological conditions 11 . BSI is treated with empirical broad-spectrum antimicrobials, which are often not efficient against the invading microbes due to the lack of specificity or resistance mechanisms 2 . Even though detection of microbial DNA in the blood does not necessarily imply the presence of viable pathogens, it is associated with worse clinical outcomes 5 12 13 ; Fig.…”

Section: Discussionmentioning

confidence: 99%

“…BSIs are routinely diagnosed by blood culture and treated by empirical broad-spectrum antimicrobials. Antimicrobial treatment might be inappropriate due to the lack of coverage of the underlying pathogen(s), or antimicrobial resistance of the causative pathogens 2 . Blood culture requires relatively large sample volumes, only detects culturable pathogens and represents a narrow spectrum of the microbes present in a sample 3 .…”

mentioning

confidence: 99%

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Metagenomic analysis of bloodstream infections in patients with acute leukemia and therapy-induced neutropenia

Gyarmati

Kjellander

Aust

et al. 2016

Sci Rep

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Leukemic patients are often immunocompromised due to underlying conditions, comorbidities and the effects of chemotherapy, and thus at risk for developing systemic infections. Bloodstream infection (BSI) is a severe complication in neutropenic patients, and is associated with increased mortality. BSI is routinely diagnosed with blood culture, which only detects culturable pathogens. We analyzed 27 blood samples from 9 patients with acute leukemia and suspected BSI at different time points of their antimicrobial treatment using shotgun metagenomics sequencing in order to detect unculturable and non-bacterial pathogens. Our findings confirm the presence of bacterial, fungal and viral pathogens alongside antimicrobial resistance genes. Decreased white blood cell (WBC) counts were associated with the presence of microbial DNA, and was inversely proportional to the number of sequencing reads. This study could indicate the use of high-throughput sequencing for personalized antimicrobial treatments in BSIs.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Metagenomic analysis of bloodstream infections in patients with acute leukemia and therapy-induced neutropenia

Gyarmati

Kjellander

Aust

et al. 2016

Sci Rep

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“…Kalich et al implemented an antibiotic-specific sepsis bundle with dosing recommendations, education to providers, and antibiotics stocked in an automated dispensing cabinet [22]. This resulted in an increase in the appropriate initial antibiotic choice from 33.9% to 54.8% (p = 0.03), however, it did not result in a significant difference in appropriate initial antibiotic choice within one hour (22.6% versus 14.5%, p = 0.36).…”

Section: Sepsismentioning

confidence: 99%

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

et al. 2019

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Antimicrobial stewardship (ASP) is becoming an increasingly high priority worldwide, yet the emergency department (ED) is an area where stewardship is often neglected. Implementing care bundles, guidelines, and protocols appears to be a rational strategy for ED stewardship given the inherently dynamic and hectic environment of care. Multiple questions still exist such as whether to target certain disease states, optimal implementation of ASP interventions in the ED, and the benefit of unique ED-specific guidelines and protocols. A narrative review was performed on interventions, guidelines, and bundles implemented in the ED setting, in an effort to improve ASP or management of infectious diseases. This review is meant to serve as a framework for the reader to implement these practices at their own institution. We examined various studies related to ASP interventions or care bundles in the ED which included: CNS infections (one study), skin and soft-tissue infections (one study), respiratory infections (four studies), urinary tract infections and sexually transmitted infections (eight studies), sepsis (two studies), culture follow-up programs (four studies), and stewardship in general or multiple infection types (five studies). The interventions in this review were diverse, yet the majority showed a benefit in clinical outcomes or a decrease in antimicrobial use. Care bundles, guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED.

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“… 1 Rheumatoid arthritis, other systemic joint disorders, and infection can also lead to the condition. 1 , 2 …”

mentioning

confidence: 99%

“…Peroneal tenosynovitis usually results from repetitive or prolonged microtrauma 1 . The tenosynovitis can be precipitated by the presence of anatomical variants such as hypertrophied peroneal tubercle after an acute trauma such as an ankle inversion injury or from displaced fracture of the lateral malleolus and calcaneus 1 . Rheumatoid arthritis, other systemic joint disorders, and infection can also lead to the condition 1, 2…”

mentioning

confidence: 99%

Peroneal Tendoscopic Debridement and Endoscopic Groove Deepening in the Prone Position

Rajbhandari

Angthong

2019

Arthroscopy Techniques

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Tendoscopy of the peroneal tendon is a promising procedure for the treatment of peroneal tendon pathology and its disorders. This procedure is minimally invasive with less physical morbidity and early functional rehabilitation. The present report demonstrates the techniques of peroneal tendoscopic debridement and endoscopic groove deepening in the prone position to treat peroneal tenosynovitis and low-lying muscle belly of peroneus brevis with a shallow and flat surface of the retro-malleolar groove. The prone position provided better ergonomics during this procedure compared with the supine position.

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Impact of an Antibiotic-specific Sepsis Bundle on Appropriate and Timely Antibiotic Administration for Severe Sepsis in the Emergency Department

Cited by 20 publications

References 25 publications

Metagenomic analysis of bloodstream infections in patients with acute leukemia and therapy-induced neutropenia

Metagenomic analysis of bloodstream infections in patients with acute leukemia and therapy-induced neutropenia

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

Peroneal Tendoscopic Debridement and Endoscopic Groove Deepening in the Prone Position

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