Timing of antibiotic administration and lactate measurement in septic shock patients: a comparison between hospital wards and the emergency department

Vattanavanit, Veerapong; Buppodom, Theerapat; Khwannimit, Bodin

doi:10.2147/idr.s155099

Cited by 9 publications

(7 citation statements)

References 26 publications

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“…In this regard, it should be noted that in our study, when doing a subgroup analysis, we did not find significant differences in mortality with the administration of antimicrobials within 1 h or within 3 h of admission to the ED in patients with septic shock, in contrast to emerging literature that suggests a greater benefit in this population [21,22,26]. These findings are similar to the results of a recent small observational study that included 150 septic shock patients admitted to the medical intensive care unit (MICU) with an in-hospital mortality rate of 49.3%; this study did not show an association between timing of antibiotic administration and mortality [31]. All this would suggest a more prudent-albeit critical-approach to the consideration of the timely and adequate initiation of antimicrobials, in which the initial resuscitation measures and the determination of the focus of infection would be critical.…”

Section: Discussionsupporting

confidence: 85%

“…It is necessary to highlight the restriction regarding the sample size, for which it is not possible to rule out a beneficial effect, although it is important to note that our sample size is one of the largest collected prospectively in a study that shows no association between early administration of antimicrobials and mortality in patients with sepsis [7,[28][29][30][31][32]. Also, the problem of residual confounding-despite the use of the propensity score and adjustment for covariates-cannot be eliminated.…”

Section: Limitationsmentioning

confidence: 99%

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Antimicrobials administration time in patients with suspected sepsis: is faster better? An analysis by propensity score

2020

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Background: Early use of antimicrobials is a critical intervention in the treatment of patients with sepsis. The exact time of initiation is controversial and its early administration may be a difficult task in crowded emergency departments (ED). The aim of this study was to estimate, using a matched propensity score, the effect on hospital mortality of administration of antimicrobials within 1 or 3 hours, in patients admitted to the ED with sepsis. Methods: This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years, hospitalized between 2014 and 2016 with suspected sepsis, and admitted to ED of three tertiary care university hospitals in Medellín, Colombia. A propensity score analysis for administration of antimicrobials, both within 1 and 3 h of admission by the ED, was fitted with 28 variables related with clinical attention and physiological changes. As a sensitivity analysis, a logistic regression model was fitted for antimicrobial use adjusted both by propensity score and confounding variables. Results: The study cohort was composed of 2454 patients with a median age of 62 years (IQR = 46-74). Among them, 32% (n = 781) received antibiotics within 3 h and 14% (n = 340) within the first hour. The main diagnoses were urinary tract infection (28%, n = 682) and pneumonia (27%, n = 671). Blood cultures were obtained in 87% (n = 2140) and yielded positive in 29% (n = 629), mainly with Escherichia coli (37%, n = 230), Staphylococcus aureus (21%, n = 132), and Klebsiella pneumoniae (10.2%, n = 64). The hospital mortality rate was 11.5% (n = 283). There were no significant differences in mortality, after adjustment, using antimicrobials either in the first hour (OR 1.03; 95% CI = 0.63; 1.70) or 3 h (OR 0.85; 95% CI = 0.61; 1.20). There were no changes with different models for sensitivity analysis. Conclusions: Despite the obvious constraints given for sample size and residual confounding, our results suggest that we need a more comprehensive approach to sepsis and its treatment, considering early detection, multiple interventions, and goals beyond the simple time-to-antimicrobials.

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Section: Discussionsupporting

confidence: 85%

Section: Limitationsmentioning

confidence: 99%

Antimicrobials administration time in patients with suspected sepsis: is faster better? An analysis by propensity score

2020

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“… 21 The timing of antibiotic administration was not associated with in-hospital mortality, similar to our previous report. 15 Although this study was not designed to evaluate the effect of the timing of antibiotic administration, our results supported the position statement of the Infectious Disease Society of America against a fixed timing of antibiotic administration with inappropriate use. 22 …”

Section: Discussionsupporting

confidence: 76%

“…These results were related to our most common source of infection being pneumonia, as in our previous sepsis studies. 14 , 15 Concordant with the source of infection, the respiratory system is the most common site of organ dysfunction in sepsis. A Spanish study reported that the highest incidence of organ failure in sepsis was respiratory failure, accounting for 74.9%.…”

Section: Discussionmentioning

confidence: 99%

<p>Presenting Symptoms in Sepsis: Is the Mnemonic “SEPSIS” Useful?</p>

Wattanapaiboon

Banditlerdruk

Vattanavanit

2020

IDR

Self Cite

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Background The mnemonic “SEPSIS” (S = Slurred speech or confusion, E = Extreme shivering or muscle pain, fever, P = Passing no urine all day, S = Severe breathlessness, I = It feels like you are going to die, S = Skin mottled or discolored) has been developed by the World Sepsis Day committee, so as to raise public awareness of the symptomatic presentation of sepsis. However, this mnemonic has not been validated. Methods A retrospective, observational, single-center study was performed. All adult septic patients presenting at the emergency department of Songklanagarind Hospital from 2016 to 2019 were included and followed up until either hospital discharge or death. Results The study included 437 patients, comprising patients with sepsis (n = 250) and those with septic shock (n = 187). Patients presented with symptoms according to the mnemonic as follows: S = 97 (22.2%), E = 240 (54.9%), P = 18 (4.1%), S =181 (41.4%), I = 5 (1.1%), and S = 5 (1.1%). Sixty-five patients (14.9%) did not present with any sepsis-specific symptoms according to the mnemonic. Compared with patients who had at least one mnemonic symptom, a higher proportion of patients without mnemonic symptoms had underlying immunosuppression (24.6% vs 8.3%, P < 0.01) and were diagnosed with intraabdominal infection (38.5% vs 12.1%, P < 0.01). In a multivariable adjusted logistic regression model, vague-presenting symptoms were independently associated with in-hospital mortality (adjusted odds ratio 2.17, 95% confidence interval 1.30−3.61, P = 0.03). Conclusion Two components of the mnemonic “SEPSIS” were rarely reported: it feels like you are going to die and skin mottled or discolored. Using the mnemonic might lead to missed diagnoses, especially in immunosuppression and intraabdominal infection. This mnemonic should be revised for the local context.

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“…8,106,107 Apart from the underdiagnosis, 108 other factors are involved in the implementation of the early administration of antibiotics. 10,[109][110][111] In a previous report, patients receiving pre-hospital emergency care and transferred to the emergency department received antibiotics earlier than patients transferred to medical wards. 109 High-quality training programs and improved interprofessional communication 10,100,[112][113][114] are associated with timely empirical antibiotic prescription prior to ICU admission.…”

Section: Early Administration Of Broad-spectrum Antibiotics Ideally In the First Hour Of Diagnosismentioning

confidence: 95%

Evidence for the Application of Sepsis Bundles in 2021

Plata-Menchaca

Ruiz‐Rodríguez

Ferrer

2021

Semin Respir Crit Care Med

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Sepsis represents a severe condition that predisposes patients to a high risk of death if its progression is not ended. As with other time-dependent conditions, the performance of determinant interventions has led to significant survival benefits and quality-of-care improvements in acute emergency care. Thus, the initial interventions in sepsis are a cornerstone for prognosis in most patients. Even though the evidence supporting the hour-1 bundle is perfectible, real-life application of thoughtful and organized sepsis care has improved survival and quality of care in settings promoting compliance to evidence-based treatments. Current evidence for implementing the Surviving Sepsis Campaign bundles for early sepsis management is moving forward to better approaches as more substantial evidence evolves.

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Timing of antibiotic administration and lactate measurement in septic shock patients: a comparison between hospital wards and the emergency department

Cited by 9 publications

References 26 publications

Antimicrobials administration time in patients with suspected sepsis: is faster better? An analysis by propensity score

Antimicrobials administration time in patients with suspected sepsis: is faster better? An analysis by propensity score

<p>Presenting Symptoms in Sepsis: Is the Mnemonic “SEPSIS” Useful?</p>

Evidence for the Application of Sepsis Bundles in 2021

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