Timeline of sepsis bundle component completion and its association with septic shock outcomes

Hu, Bo; Xiang, Hui; Dong, Yue; Portner, Erica R; Peng, Zhiyong; Kashani, Kianoush

doi:10.1016/j.jcrc.2020.07.027

Cited by 11 publications

(10 citation statements)

References 29 publications

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“…Sepsis is different from other emergent conditions such as acute coronary syndrome, stroke, or trauma in terms of disease onset although appropriate and timely detection and treatment should be essential in improving the outcome of sepsis. A recent retrospective cohort study showed no association between completion of hour-1 bundle components within 1 hour and lower mortality, whereas bundle completion within 3 hours was associated with lower mortality [9]. In that study, the hour-1 bundle was completed in only 8% of the patients, whereas it was completed in half of the patients in the present study.…”

Section: Discussioncontrasting

confidence: 75%

“…The effectiveness of the hour-1 bundle has not been fully evaluated because fundamentally, initiation of earlier treatment does not negatively affect the disease. A recent study did not show an association between completion of the hour-1 bundle components within 1 hour and lower mortality, whereas they did show an association between care completed within 3 hours and lower mortality [9]. In addition, a randomized controlled trial in the pre-hospital setting that assessed early antibiotic use in patients with suspected infection showed that it failed to reduce mortality [10].…”

Section: Read Full License Introductionmentioning

confidence: 94%

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Hour-1 Bundle Adherence Was Associated With Reduction of In-Hospital Mortality Among Patients With Sepsis In Japan

Umemura

Abe

Ogura

et al. 2021

Preprint

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Background: The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle, however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients.Methods: This is a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to the ICUs from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses.Results: The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level; obtain blood cultures; administer broad-spectrum antibiotics; administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50.3%. In-hospital mortality was 18.0% in patients with and 30.3% in patients without bundle-adherent care (p=0.054) Adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09–4.95) using propensity score. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour were related to in-hospital mortality (2.65 [95% CI 1.25–5.62] and 4.81 [95% CI 1.38–16.72], respectively). Adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04–1.57) by logistic regression analysis.Conclusion: Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality.

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Section: Discussioncontrasting

confidence: 75%

Section: Read Full License Introductionmentioning

confidence: 94%

Hour-1 Bundle Adherence Was Associated With Reduction of In-Hospital Mortality Among Patients With Sepsis In Japan

Umemura

Abe

Ogura

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Sepsis is different from other emergent conditions such as acute coronary syndrome, stroke, or trauma in terms of disease onset, although appropriate and timely detection and treatment should be essential in improving the outcome of sepsis. A recent retrospective cohort study showed no association between completion of the hour-1 bundle components within 1 hour and lower mortality, whereas bundle completion within 3 hours was associated with lower mortality [ 9 ]. In that study, the hour-1 bundle was completed in only 8% of the patients, whereas it was completed in half of the patients in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies showed significant associations between bundle-adherent care completed within 3 hours and lower mortality. To date, however, little evidence has been provided of an association between completion of the hour-1 bundle components within 1 hour and lower mortality [ 9 , 10 ]. In addition, a randomized controlled trial in the pre-hospital setting that assessed early antibiotic use in patients with suspected infection showed that it failed to reduce mortality [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan

et al. 2022

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Background The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle; however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients. Methods This was a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to intensive care units from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses. Results The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level, obtain blood cultures, administer broad-spectrum antibiotics, administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50%. In-hospital mortality was 18.0% in the patients with and 30.3% in the patients without bundle-adherent care (p = 0.054). The adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09–4.95) using propensity scoring. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour was related to in-hospital mortality (2.65 [95% CI 1.25–5.62] and 4.81 [95% CI 1.38–16.72], respectively). The adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04–1.57) by logistic regression analysis. Conclusion Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality.

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“…4 Previous studies have demonstrated that delayed antibiotic administration increases the risk of mortality in patients with sepsis. [5][6][7][8] Therefore, the Surviving Sepsis Campaign guidelines (SSCG) recommend initiating broad-spectrum antibiotic coverage within the first hour of identifying sepsis or septic shock and administering antibiotics as soon as possible to patients with sepsis is a widely accepted treatment. 2 However, early diagnosis of sepsis is difficult; therefore, initiation of treatment is sometimes delayed.…”

mentioning

confidence: 99%

Improving Antibiotic Administration Rate for Patients With Sepsis in the Emergency Department

Hatozaki

Sakuramoto

Okamoto

et al. 2021

Journal of Nursing Care Quality

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Background: Previous studies have demonstrated that delayed antibiotic administration increases the risk of mortality in patients with sepsis. Local Problem: In the emergency department, the antibiotic administration rate within 1 and 3 hours for patients with suspected sepsis was low. Methods/Interventions: We implemented an educational intervention with the nursing staff, which included training sessions and feedback, to ensure early detection and management of patients with suspected sepsis. Antibiotic administration rates were compared before and after education. Results: A total of 503 patients were included. The antibiotic administration rate improved as the phases continued (1 hour: from 5.2% to 15.6%, P = .004; 3 hours: from 35.6% to 49.7%, P = .04; 6 hours: from 74.1% to 89.1%, P = .002). The time to initial antibiotic administration also improved from 229 to 185 minutes (P < .001). Conclusions: Nurse-initiated quality improvement improved the early administration of antibiotics for patients with suspected sepsis.

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Timeline of sepsis bundle component completion and its association with septic shock outcomes

Cited by 11 publications

References 29 publications

Hour-1 Bundle Adherence Was Associated With Reduction of In-Hospital Mortality Among Patients With Sepsis In Japan

Hour-1 Bundle Adherence Was Associated With Reduction of In-Hospital Mortality Among Patients With Sepsis In Japan

Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan

Improving Antibiotic Administration Rate for Patients With Sepsis in the Emergency Department

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