Time to Administration of Antibiotics among Inpatients with Severe Sepsis or Septic Shock

Mok, Kelly; Christian, Michael D.; Nelson, Sandra; Burry, Lisa

doi:10.4212/cjhp.v67i3.1358

Cited by 24 publications

(33 citation statements)

References 20 publications

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“…The timely administration of antibiotics is particularly important. The mortality rate from severe sepsis approaches 35 per cent, and several studies have demonstrated a survival benefit for patients treated with empirical antibiotics within 1 h of diagnosis. Although three‐quarters of patients were given antibiotics, only one‐third were delivered within 1 h of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery

Blencowe

Strong

Blazeby

et al. 2017

British Journal of Surgery

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Background: Evidence-based interventions may reduce mortality in surgical patients. This study documented the prevalence of sepsis, adherence to guidelines in its management, and timing of source control in general surgical patients presenting as an emergency.Methods: Patients aged 16 years or more presenting with emergency general surgery problems were identified over a 7-day period and then screened for sepsis compliance (using the Sepsis Six standards, devised for severe sepsis) and the timing of source control (whether radiological or surgical). Exploratory analyses examined associations between the mode (emergency department or general practitioner) and time of admission, adherence to the sepsis guidelines, and outcomes (complications or death within 30 days).Results: Of a total of 5067 patients from 97 hospitals across the UK, 911 (18⋅0 per cent) fulfilled the criteria for sepsis, 165 (3⋅3 per cent) for severe sepsis and 24 (0⋅5 per cent) for septic shock. Timely delivery of all Sepsis Six guidelines for patients with severe sepsis was achieved in four patients. For patients with severe sepsis, 17⋅6-94⋅5 per cent of individual guidelines within the Sepsis Six were delivered. Oxygen was the criterion most likely to be missed, followed by blood cultures in all sepsis severity categories. Surgery for source control occurred a median of 19⋅8 (i.q.r. 10⋅0-35⋅4) h after diagnosis. Omission of Sepsis Six parameters did not appear to be associated with an increase in morbidity or mortality. Conclusion:Although sepsis was common in general surgical patients presenting as an emergency, adherence to severe sepsis guidelines was incomplete in the majority. Despite this, no evidence of harm was apparent. * Members of the UK National Surgical Research Collaborative are co-authors of this study and can be found under the heading Collaborators Paper accepted 25 October 2016Published online in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.10432 IntroductionGeneral surgical patients presenting as an emergency account for over 7 per cent of hospital episodes in the USA and 14 000 ICU admissions per year in the UK 1 -3 . Sepsis is prevalent in this patient group. Early diagnosis of severe sepsis and initiation of goal-directed therapy can reduce mortality, irrespective of the need for surgery 4,5 . This evidence was used to develop a care bundle known as the Sepsis Six for managing patients with severe sepsis (Table 1) 6,7 . These standards have been endorsed by many professional organizations, including the Society of Critical Care Medicine, the European Society of Intensive Care Medicine and the Royal Colleges of Surgeons of England and Ireland 1,2,8,9 . Complete application of these interventions is thought to be associated with as much as a one-third reduction in mortality from sepsis, although uptake is uncertain amongst surgical patients presenting as an emergency 4,6 .The main aims of the present study were to assess adherence to the Sepsis Six guidelines and identify the timing of source control in general su...

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Section: Discussionmentioning

confidence: 99%

Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery

Blencowe

Strong

Blazeby

et al. 2017

British Journal of Surgery

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“…Data for the 11 studies were developed between 2005 and 2013 with subsequent publication dates ranging from 2009 to 2016 (see Table 1). The trials were conducted in various countries: five in USA (including one multi-continent study including Europe) 6,[22][23][24][25] , one included a broad grouping 'Europe' 26 , and one each in Korea 27 , Canada 28 , The Netherlands 29 , Australia 30 and Iran 31 (see Table 1). The population of each study varied and included SIRS, sepsis, severe sepsis and septic shock.…”

Section: Resultsmentioning

confidence: 99%

Effect of Immediate Administration of Antibiotics in Patients With Sepsis in Tertiary Care: A Systematic Review and Meta-analysis

Johnston

Park

Doi

et al. 2017

Clinical Therapeutics

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“…13 In patients with severe sepsis and septic shock, prompt treatment of infection is the cornerstone of therapy and predictive of survival. 10 To select the right antimicrobial for the offending pathogen, knowledge of the causative organisms and their local antimicrobial susceptibility patterns is pivotal. In the present study, the vast majority of isolates were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.…”

Section: Discussionmentioning

confidence: 99%

“…2,[6][7] Sepsis, resulting due to impairment of host defences to infection, [8][9] requires prompt implementation of antibiotic therapy to reduce morbidity and mortality. 10 Epidemiological studies have reported an increase in the incidence of severe sepsis and septic shock [11][12] with even gram positive and fungal organisms being the causative agents. 13 Thus, it is essential to have knowledge about the local epidemiological pat tern among the severe sepsis and septic shock patients since the organisms causing sepsis may not only vary based on regions but also change over time.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Antimicrobial Resistant Pathogens in Severe Sepsis and Septic Shock Patients

Babu¹,

Menon²,

P³

2018

JYP

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Emergence of antimicrobial resistance is turning to be a life threatening problem in the treatment of patients with severe sepsis and septic shock. Many organisms display a multidrug resistant (MDR) pattern, which limits the treatment options. Aim: The purpose of this study was to assess the prevalence of pathogens including the resistant types causing severe sepsis and septic shock as well as their antimicrobial resistance patterns. Methods: This was a prospective, observational study conducted at emergency department of a tertiary care hospital. A total of 293 bacterial isolates obtained during April 2015-16 inclusive, from severe sepsis and septic shock patients underwent susceptibility testing. Results: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Candida albicans and Candida non-albicans were the most common organisms.With respect to the specimen source, majority of the isolates (38.6%) were obtained from urine specimens followed by blood (27%), skin/soft tissue specimen (16.4%) and respiratory specimen (15%). Escherichia coli showed good susceptibility to amikacin, meropenem and piperacillin-tazobactam. Klebsiella pneumoniae showed high rates of resistance to all the tested antimicro- This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. 359 patients had a single site infection while 47 patients had multiple site infections. Overall, 293 isolates were obtained (240 isolates from severe sepsis patients and 53 isolates from septic shock patients). With regard to specimen source, 38.6% (113/293) of the organisms were obtained from urine specimens, 27% (79/293) from blood, 16.4% (48/293) from skin/ soft tissue specimens, and 15% (44/293) from respiratory specimens. The remaining organisms were obtained from ascitic/peritoneal fluid, synovial fluid and bone. Most common microorganisms isolatedIn the present study, gram negative organisms were predominant (177/293, 60.4%) followed by gram positive (68/293, 23.2%) and fungi (48/293, 16.4%). Overall, the most common isolates were Escherichia coli (20.8%), Klebsiella pneumoniae (18.8%), Pseudomonas aeruginosa (7.8%), Candida albicans (6.1%) and Candida non-albicans (5.8%). The most common isolates among severe sepsis patients were Escherichia coli (52/240, 21.7%), Klebsiella pneumoniae (44/240, 18.3%), Pseudomonas aeruginosa (21/240, 8.8%), Candida albicans (15/240, 6.3%), Candida non-albicans (14/240, 5.8%). The most common isolates among septic shock patients were Klebsiella pneumoniae (11/53, 20.8%), Escherichia coli (9/53, 17%), Candida albicans (3/53, 5.7%), Candida non-albicans (3/53, 5.7%) and Candida tropicalis (3/53, 5.7%). The distribution of prevalent microbial species were found to be similar between patients with severe sepsis and septic shock. Most common microorganisms isol...

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Time to Administration of Antibiotics among Inpatients with Severe Sepsis or Septic Shock

Abstract: Background: Current evidence suggests that administration of appropriate antibiotic therapy within 1 h after the onset of hypotension significantly improves mortality rates among patients with severe sepsis and septic shock.

Cited by 24 publications

References 20 publications

Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery

Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery

Effect of Immediate Administration of Antibiotics in Patients With Sepsis in Tertiary Care: A Systematic Review and Meta-analysis

Prevalence of Antimicrobial Resistant Pathogens in Severe Sepsis and Septic Shock Patients

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