Time to decision in sepsis

Abstract

Introduction. This study aimed to identify the common barriers leading to delayed initial management, microbiological diagnosis, and appropriate empirical antimicrobial treatment in sepsis. Patients and methods. A cross-sectional study was performed by the application of a population-based survey. Four different surveys were designed, targeting the healthcare personnel located in main hospital areas [emergency department (SEMES); infectious diseases and clinical microbiology-microbiological diagnosis (SEIMC-M); intensive care and infectious diseases, (SEMICYUC-GTEIS); and infectious diseases and clinical microbiology-clinical diagnosis, (SEIMC-C)]. Results. A total of 700 valid surveys were collected from June to November 2019: 380 (54.3%) of SEMES, 127 (18.1%) of SEIMC-M, 97 (13.9%) de SEMICYUC-GTEIS and 96 (13.7%) of SEIMC-C, in 270 hospitals of all levels of care. The qSOFA score was used as a screening tool. The most used biomarker was procalcitonin (n=92, 39.8%). The sepsis code was implemented in 157 of 235 participating centers (66.2%), particularly in tertiary level hospitals. The mean frequency of contaminated blood cultures was 8.9% (8.7). In 85 (78.7%) centers, positive results of blood cultures were available within the first 72 hours and were communicated to the treating physician effectively by phone or e-mail in 76 (81.7%) cases. The main reason for escalating treatment was clinical deterioration, and the reason for de-escalating antimicrobials was significantly different between the specialties. Quality indicators were not frequently monitored among the different participating centers. Conclusion. There are significant barriers that hinder adequate management processes in sepsis in Spanish hospitals.

Perceptions of Relatives about Symptoms and Signs in Older Adults with Sepsis: A Cross-Sectional Study

“…It is challenging for healthcare personnel to diagnose and provide treatment within 72 hours to prevent clinical deterioration and maintain life effectively. 12 Most older adults with sepsis are more inclined to delay seeking treatment for sepsis symptoms and signs. Low perceptions about the symptoms and signs of sepsis are the main cause of delayed arrival time at the hospital.…”

The microbiology of sepsis is more than the application of new technologies in diagnosis

“…The results of diagnostic tests, especially BCs, must be clearly and immediately reported to the clinical team, especially if the patient is not receiving adequate empirical antibiotic therapy. For this, it is essential that laboratories be open 24h/7d [ 15 ]. The clinical microbiologist should not be limited to simple issuing reports by conventional means; automatic alert systems should be developed through immediate messaging or by specific Web Apps that transmit critical information and obtain return confirmation of the display of these results and, if possible, information as to whether they have generated any action on the treatment.…”