Prehospital Antibiotics Improve Morbidity and Mortality of Emergency Medical Service Patients with Sepsis

Abstract

Background Severe sepsis is a major cause of mortality in patients evaluated in the Emergency Department (ED). Early initiation of antibiotic therapy and IV fluids in the ED is associated with improved outcomes. We investigated whether early administration of antibiotics in the prehospital setting improves outcomes in these patients with sepsis. Methods This is a retrospective study comparing outcomes of patients meeting sepsis criteria in the field by EMS, who were treated with IV fluids and antibiotics. Their outcomes were compared with controls where fluids were administered prehospital and antibiotics were initiated in the ED. We compared morbidity and mortality between these groups. Results Early antibiotics and fluids were demonstrated to show significant improvement in outcomes in the patients meeting sepsis criteria treated in the pre-hospital setting. The average age for sepsis patients receiving antibiotics in the prehospital setting was statistically higher than that for patients in the historical control group, 73.23 years and 67.67, respectively (p < 0.036), and there was no statistically significant difference of Charlson Comorbidity Index between the groups (p two-tail = 0.28). Average intensive care unit length of stay was 2.51 days in the in the prehospital group and 5.18 days in the historical controls, and the prehospital group received fewer blood products than the historical controls (p = 0.0003). Conclusions Early IV administration of antibiotics in the field significantly improves outcome in EMS patients who meet sepsis criteria based on a modified qSOFA score.

A pilot study of prehospital antibiotics for severe sepsis

“…Our pilot investigation demonstrated that implementing a prehospital protocol for initiation of prehospital antibiotics was feasible and safe, with high paramedic adherence to the protocol. Additional multicenter research is warranted; however, our safety/feasibility findings were consistent with results from the other U.S.-based investigations and multiple European studies, [4][5][6][7][8] Further research is needed to confirm that prehospital antibiotic administration translates to better patient outcomes.…”

“…[4][5][6] Few American systems have begun examining similar prehospital antibiotic administration protocols. 7,8 These early studies have demonstrated evidence of improved patient outcomes including shorter intensive care unit (ICU) lengths of stay. 7,8 The primary aim of our investigation was to describe the safety and feasibility of a protocol for prehospital recognition of sepsis with hypotension and septic shock, drawing of blood cultures, and administration of intravenous (IV) antibiotics in an urban EMS service, thereby adding to the limited U.S. literature available on this subject and supporting the development of a large-scale randomized control trial (RCT).…”

“…7,8 These early studies have demonstrated evidence of improved patient outcomes including shorter intensive care unit (ICU) lengths of stay. 7,8 The primary aim of our investigation was to describe the safety and feasibility of a protocol for prehospital recognition of sepsis with hypotension and septic shock, drawing of blood cultures, and administration of intravenous (IV) antibiotics in an urban EMS service, thereby adding to the limited U.S. literature available on this subject and supporting the development of a large-scale randomized control trial (RCT). Primary feasibility measures included the frequency of allergic reactions, culture contamination, and paramedic adherence to the protocol in the prehospital environment.…”

Prehospital administration of broad‐spectrum antibiotics for sepsis patients: A systematic review and meta‐analysis

“…We did sensitivity analysis with a leave one out test. We removed the (Martel et al 11 ) study, so the heterogeneity was solved ( p = 0.71). After postsensitivity analysis, the pooled MD for patients who took prehospital antibiotics was 1.18 (95% CI: 0.30–2.06, p = 0.91) compared to those who did not take prehospital antibiotics.…”

The experiences of sepsis in people with a learning disability—a qualitative investigation

“…Despite increased awareness of the condition meaning that screening for sepsis has increased in emergency healthcare settings (rising from 52 to 87 per cent between 2015 and 2017; Burki, 2018), some practitioners still lack awareness of the presenting symptoms of sepsis. Early administration of antibiotics is critical in successfully treating sepsis and reducing the risk of mortality (Martel et al, 2020; Seymour et al, 2017). Research suggests that difficulties remain with the timely diagnosis of sepsis, rather than the lack of effective medications and treatment once sepsis has been correctly identified (Burki, 2018; Kim & Park, 2019).…”