Is Surviving Sepsis Campaign compliance all but impossible?

  • Ann Emerg Med

  • International Clinical Digest
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Takeaway

  • This institution concluded that getting septic patients antibiotics within an hour was inadvisable because of: 
    • Risk of encouraging inappropriate antibiotic use.
    • Diverting resources to patients with vague presentation or stable vitals.

Why this matters

  • Controversially, the 2018 Surviving Sepsis Campaign (SSC) update recommends antibiotics within 1 hour of triage to patients with sepsis.
  • 1 meta-analysis found no benefit to antibiotics within 3 hours of triage or 1 hour of shock.

Key results

  • Antibiotic delay, post- vs preintervention:
    • 3-hour delay: 21% vs 30% (change, −9%; 95% CI, −16% to −2%).
    • 1-hour delay: 71% vs 85% (change, −14%; 95% CI, −20% to −8%).
  • Factors associated with delay:
    • Vague presenting symptoms.
    • Triage to nonacute areas.
    • Presenting preintervention.
    • Lower Sequential Organ Failure Assessment score.
  • Subgroup who got antibiotics within 1 hour presented with overt hypotension and explicit symptoms.
  • Authors: "It is our opinion that currently the 2018 SSC recommendations about antibiotic timing are unjustifiable."

Study design

  • 2-year retrospective before-and-after cohort study of consecutive adults presenting to the emergency department (ED) with septic shock (N=654). 
  • Halfway through, the ED introduced a sepsis quality improvement intervention.
  • Outcomes: delayed antibiotics (>3 hours and >1 hour).
  • Funding: 
    • MIT-MGH Strategic Partnership.
    • CRICO Risk Management Foundation.
    • Nihon Kohden Corporation.
    • National Foundation of Emergency Medicine. 

Limitations

  • Single-center study.