Audit of empirical antibiotic therapy for sepsis and the impact of early multidisciplinary consultation on patient outcomes.

Autor: D'Onofrio V; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands., Meersman A; Emergency Department, Jessa Hospital, Hasselt, Belgium., Magerman K; Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium., Waumans L; Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium., van Halem K; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium., Cox JA; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium., van der Hilst JC; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium., Cartuyvels R; Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium., Messiaen P; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium., Gyssens IC; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: inge.gyssens@radboudumc.nl.
Jazyk: angličtina
Zdroj: International journal of antimicrobial agents [Int J Antimicrob Agents] 2021 Sep; Vol. 58 (3), pp. 106379. Date of Electronic Publication: 2021 Jun 20.
DOI: 10.1016/j.ijantimicag.2021.106379
Abstrakt: Objectives: To perform an audit of empirical antibiotic therapy (EAT) of sepsis at the emergency department and to analyse the impact of an antimicrobial stewardship (AMS) programme on process and patient outcomes.
Patients and Methods: A prospective, single-centre cohort study including patients with sequential organ failure assessment (SOFA) score ≥2 from whom blood cultures were taken was conducted between February 2019 and April 2020. EAT was assessed using eight applicable inpatient quality indicators (IQIs) for responsible antibiotic use. Patient outcomes were hospital length-of-stay (LOS), ICU admission, ICU LOS, and in-hospital mortality.
Results: The audit included 900 sepsis episodes in 803 patients. Full guideline adherence regarding choice and dosing was 45.9%; adherence regarding choice alone was 68.1%. EAT was active against all likely pathogens in 665/787 (84.5%) episodes. In the guideline non-adherent group, choice of EAT was inappropriate in 122/251 (48.6%) episodes. Changes within 3 days occurred in 335/900 (37.2%) episodes. Treating physicians changed administration route more often, whereas microbiological/infectious disease (ID)/AMS consultant advice resulted in de-escalation and discontinuation (P = 0.000). Guideline-adherent choice was associated with significantly shorter LOS (6 (4-11) vs. 8 (5-15) days). Full adherence was associated with significantly lower mortality (23 (6.4%) vs. 48 (11.3%)) and shorter LOS (6 (4-10) vs. 8 (5-14) days).
Conclusion: Five global quality indicators of EAT were measurable in routine clinical practice. Full adherence to guidelines was only moderate. Adherence to guidelines was associated with better patient outcomes.
(Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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