Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study
Por:
Ferrer R, Martínez ML, Gomà G, Suárez D, Álvarez-Rocha L, de la Torre MV, González G, Zaragoza R, Borges M, Blanco J, Herrejón EP and Artigas A
Publicada:
22 jun 2018
Categoría:
Critical care and intensive care medicine
Resumen:
Background: Early appropriate antibiotic treatment is essential in sepsis. We aimed to evaluate the impact of a multifaceted educational intervention to improve antibiotic treatment. We hypotheyzed that the intervention would hasten and improve the appropriateness of empirical antibiotic administration, favor de-escalation, and decrease mortality.
Methods: We prospectively studied all consecutive patients with sepsis/septic shock admitted to 72 intensive care units (ICUs) throughout Spain in two 4-month periods (before and immediately after the 3-month intervention). We compared process-of-care variables (resuscitation bundle and time-to-initiation, appropriateness, and de-escalation of empirical antibiotic treatment) and outcome variables between the two cohorts. The primary outcome was hospital mortality. We analyzed the intervention's long-term impact in a subset of 50 ICUs.
Results: We included 2628 patients (age 64.1 +/- 15.2 years; men 64.0%; Acute Physiology and Chronic Health Evaluation (APACHE) II, 22.0 +/- 8.1): 1352 in the preintervention cohort and 1276 in the postintervention cohort. In the postintervention cohort, the mean (SD) time from sepsis onset to empirical antibiotic therapy was lower (2.0 (2.7) vs. 2.5 (3.6) h; p= 0.002), the proportion of inappropriate empirical treatments was lower (6.5% vs. 8.9%; p= 0.024), and the proportion of patients in whom antibiotic treatment was de-escalated was higher (20.1% vs. 16.3%; p= 0.004); the expected reduction in mortality did not reach statistical significance (29.4% in the postintervention cohort vs. 30.5% in the preintervention cohort; p= 0.544). Gains observed after the intervention were maintained in the long-term follow-up period.
Conclusions: Despite advances in sepsis treatment, educational interventions can still improve the delivery of care; further improvements might also improve outcomes.
Filiaciones:
Ferrer R:
Intensive Care Department, Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
CIBER Enfermedades Respiratorias, Madrid, Spain.
Martínez ML:
Intensive Care Department, Hospital Universitario General de Catalunya, Autonomous University of Barcelona, Sant Cugat del Vallés, Spain
Gomà G:
Intensive Care Department, Corporación Sanitaria Universitaria Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
Suárez D:
Epidemiology and Assessment Unit, Fundació Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
Álvarez-Rocha L:
Intensive Care Department, Hospital Universitario de la Coruña, A Coruña, Spain
de la Torre MV:
Intensive Care Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
González G:
Intensive Care Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
:
Intensive Care Department, Hospital Universitario Doctor Peset, Valencia, Spain
Borges M:
Intensive Care Department, Hospital Son Llatzer, Palma de Mallorca, Spain
Blanco J:
CIBER Enfermedades Respiratorias, Madrid, Spain
Intensive Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
Herrejón EP:
Intensive Care department, Hospital Universitario Infanta Leonor, Madrid, Spain
Artigas A:
CIBER Enfermedades Respiratorias, Madrid, Spain
Intensive Care Department, Hospital Universitario General de Catalunya, Autonomous University of Barcelona, Sant Cugat del Vallés, Spain
Intensive Care Department, Corporación Sanitaria Universitaria Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
Open Access
|