Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study
Abstract 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 hypothesized that the intervention would hasten and improve the appropriateness of empirical antibiotic ad...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2091-0 |
| _version_ | 1818494250766041088 |
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| author | Ricard Ferrer María Luisa Martínez Gemma Gomà David Suárez Luis Álvarez-Rocha María Victoria de la Torre Gumersindo González Rafael Zaragoza Marcio Borges Jesús Blanco Eduardo Palencia Herrejón Antonio Artigas for the ABISS-Edusepsis Study group |
| author_facet | Ricard Ferrer María Luisa Martínez Gemma Gomà David Suárez Luis Álvarez-Rocha María Victoria de la Torre Gumersindo González Rafael Zaragoza Marcio Borges Jesús Blanco Eduardo Palencia Herrejón Antonio Artigas for the ABISS-Edusepsis Study group |
| author_sort | Ricard Ferrer |
| collection | DOAJ |
| description | Abstract 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 hypothesized 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. |
| first_indexed | 2024-12-10T18:04:07Z |
| format | Article |
| id | doaj.art-64abc3e18ee3464a8834921ee0b2fb29 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-10T18:04:07Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-64abc3e18ee3464a8834921ee0b2fb292022-12-22T01:38:41ZengBMCCritical Care1364-85352018-06-0122111010.1186/s13054-018-2091-0Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis studyRicard Ferrer0María Luisa Martínez1Gemma Gomà2David Suárez3Luis Álvarez-Rocha4María Victoria de la Torre5Gumersindo González6Rafael Zaragoza7Marcio Borges8Jesús Blanco9Eduardo Palencia Herrejón10Antonio Artigas11for the ABISS-Edusepsis Study groupIntensive Care Department, Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute, Vall d’Hebron University Hospital, Autonomous University of BarcelonaIntensive Care Department, Hospital Universitario General de Catalunya, Autonomous University of BarcelonaIntensive Care Department, Corporación Sanitaria Universitaria Parc Taulí, Autonomous University of BarcelonaEpidemiology and Assessment Unit, Fundació Parc Taulí, Autonomous University of BarcelonaIntensive Care Department, Hospital Universitario de la CoruñaIntensive Care Department, Hospital Universitario Virgen de la VictoriaIntensive Care Department, Hospital General Universitario Morales MeseguerIntensive Care Department, Hospital Universitario Doctor PesetIntensive Care Department, Hospital Son LlatzerCIBER Enfermedades RespiratoriasIntensive Care department, Hospital Universitario “Infanta Leonor”CIBER Enfermedades RespiratoriasAbstract 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 hypothesized 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.http://link.springer.com/article/10.1186/s13054-018-2091-0SepsisSeptic shockQuality improvementTiming of antibioticsDe-escalationHospital mortality |
| spellingShingle | Ricard Ferrer María Luisa Martínez Gemma Gomà David Suárez Luis Álvarez-Rocha María Victoria de la Torre Gumersindo González Rafael Zaragoza Marcio Borges Jesús Blanco Eduardo Palencia Herrejón Antonio Artigas for the ABISS-Edusepsis Study group Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study Critical Care Sepsis Septic shock Quality improvement Timing of antibiotics De-escalation Hospital mortality |
| title | Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study |
| title_full | Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study |
| title_fullStr | Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study |
| title_full_unstemmed | Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study |
| title_short | Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study |
| title_sort | improved empirical antibiotic treatment of sepsis after an educational intervention the abiss edusepsis study |
| topic | Sepsis Septic shock Quality improvement Timing of antibiotics De-escalation Hospital mortality |
| url | http://link.springer.com/article/10.1186/s13054-018-2091-0 |
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