Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study
Por:
Ferrer, R, Martinez, ML, Goma, G, Suarez, D, Alvarez-Rocha, L, de la Torre, MV, Gonzalez, G, Zaragoza, R, Borges, M, Blanco, J, Herrejon, EP, Artigas, A, Zapata L., Vera P., Cremades, Isabel
Publicada:
22 jun 2018
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:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Intens Care Dept,Shock Organ Dysfunct & Resuscita, Barcelona, Spain
CIBER Enfermedades Resp, Madrid, Spain
Martinez, ML:
Autonomous Univ Barcelona, Hosp Univ Gen Catalunya, Intens Care Dept, Sant Cugat Del Valles, Spain
Goma, G:
Autonomous Univ Barcelona, Intens Care Dept, Corp Sanitaria Univ Parc Tauli, Sabadell, Spain
Suarez, D:
Autonomous Univ Barcelona, Epidemiol & Assessment Unit, Fundacio Parc Tauli, Sabadell, Spain
Alvarez-Rocha, L:
Hosp Univ Coruna, Intens Care Dept, La Coruna, Spain
de la Torre, MV:
Hosp Univ Virgen Victoria, Intens Care Dept, Malaga, Spain
Gonzalez, G:
Hosp Gen Univ Morales Meseguer, Intens Care Dept, Murcia, Spain
Zaragoza, R:
Hosp Univ Doctor Peset, Intens Care Dept, Valencia, Spain
Borges, M:
Hosp Son Llatzer, Intens Care Dept, Palma De Mallorca, Spain
Blanco, J:
CIBER Enfermedades Resp, Madrid, Spain
Hosp Univ Rio Hortega, Intens Care Dept, Valladolid, Spain
Herrejon, EP:
Hosp Univ Infanta Leonor, Intens Care Dept, Madrid, Spain
Artigas, A:
CIBER Enfermedades Resp, Madrid, Spain
Autonomous Univ Barcelona, Hosp Univ Gen Catalunya, Intens Care Dept, Sant Cugat Del Valles, Spain
Autonomous Univ Barcelona, Intens Care Dept, Corp Sanitaria Univ Parc Tauli, Sabadell, Spain
Zapata L.:
Hospital de la Santa Creu i Sant Pau, Spain
Vera P.:
Hospital de la Santa Creu i Sant Pau, Spain
Cremades, Isabel:
Hospital Puerta del Hierro, Spain
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