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ID team increases survival of patients with severe sepsis/septic shock
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A designated team of infectious disease specialists treating severe sepsis or septic shock can improve a patient’s chance of survival, according to researchers.
The team can also improve compliance with sepsis management recommendations and antibiotic use, they wrote in Clinical Infectious Diseases.
“The present study describes a novel approach to the management of patients with severe sepsis/septic shock cared for by the emergency department,” the researchers wrote. “This model, based on the early bedside involvement of an infectious disease specialist, has been effective in reducing 14-day mortality by improving not only the approach to microbiological work-up and antimicrobial administration, but the compliance to the items of the Surviving Sepsis Campaign bundle and further patient care.”
The quasi-experimental, pre-post study was conducted at a 1,420-bed teaching hospital at the University of Bologna, Italy. Altogether, it included 382 patients with severe sepsis or septic shock (SS/SS).
The lung (43%) and urinary tract (17%) were the most common infection sources. The infection source was unknown in 22% of cases.
The study’s pre-phase cohort consisted of 195 patients treated between June 2013 and July 2014. Those patients were treated according to standard of care without the infectious disease team, or so-named sepsis team, which comprised 13 infectious disease specialists. ED physicians managed the patients and could consult infectious disease specialists if they felt the need.
The post-phase cohort consisted of 187 patients with SS/SS treated between August 2014 and October 2015. They were treated by ED physicians working with members of the sepsis team.
Post-phase management included patient evaluation within 1 hour of notification of SS/SS, recommendations for diagnostic work-up, antibiotic therapy with drugs deemed appropriate and indication for source control if needed. The sepsis team followed all patients included in the study for up to 30 days after admission.
Among the pre- and post-phase cohorts, respectively, the median ages were 84 and 80 years (P = .008), the median Charlson comorbidity indexes were 7 and 5 (P < .001) and septic shock rates were 7.2% and 17.6% (P = .002).
Of the patients in the pre-phase study, 39% died within 14 days of ED admission, compared with 29% of post-phase patients (P = .02). Predictors of all-cause mortality at 14 days were a quick sepsis-related organ failure assessment score of 2 or less (HR = 1.68; 95% CI, 1.15-2.45; P = .007), serum lactate measurement of 2 mmol/L or less (HR = 2.13; 95% CI, 1.39-3.25; P < .001) and unknown infection source (HR = 2.07; 95% CI, 1.42-3.02; P < .001). Patient management that included sepsis team members proved to be a protective factor (HR = 0.64; 95% CI, 0.43-0.94; P = .026).
The researchers also assessed compliance with the Surviving Sepsis Campaign (SSC) bundle, a set of care measures meant to decrease sepsis-related deaths, used at the Bologna hospital. Of specific SSC measures among the pre- and post-phase cohorts respectively, lactate measurements were taken in 76% and 90% of cases (P < .001), fluid resuscitation was given in 56% and 70% (P = .004), blood cultures were drawn in 20% and 84% (P < .001) and the first antibiotic dose was given within 3 hours of admission in 43% and 58% (P = .03).
Physicians applied the appropriate empiric antibiotics in 30% of the pre-phase cohort and 79% of the post-phase cohort (P < .001). Also, they switched to targeted therapy in 13% and 43.6% of cases (P < .001), respectively.
The researchers stressed that the median patient age of 82 years differed greatly from those in similar studies in which it ranged between 60 and 65 years, yet sepsis team collaboration still had a significant impact on outcomes.
“Despite older age, comorbidities and difficulties in identifying the infection source ... the intervention of the sepsis team was a significant protective factor,” they wrote. “Also very favorable were the improved use of microbiological resources, with a higher rate of etiological diagnosis, and of antimicrobials.” – by Joe Green
Disclosure: The researchers report no relevant financial disclosures.
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