Abstract
ObjectivesThere has been concern that the imperative to administer rapid antimicrobials in septic patients may result in inappropriate antimicrobial use. We aimed to determine the impact of early antimicrobial stewardship (AMS) team intervention in patients with Medical Emergency Team (MET) calls for suspected sepsis.MethodsWe performed a randomized controlled trial of non-ICU inpatients who had a MET call for suspected sepsis. Patients were randomized to standard care (management of antimicrobial therapy by the treating team) or early targeted intervention (AMS review 48 h post-MET call). The primary outcome was appropriateness of antimicrobial therapy 72 h post-MET call, as determined by a panel of blinded infectious diseases physicians.ResultsIn total, 90 patients were enrolled; 45 were randomly allocated to the intervention group, and 45 to the control group. More patients in the AMS intervention group were receiving appropriate antimicrobials 72 h following the MET call (67% versus 44%, P = 0.03). In the intervention group, 27 recommendations were made by the AMS team; 74% of recommendations were accepted, including 30% of cases where antimicrobials were discontinued or de-escalated. There were non-significant differences in total duration of antimicrobial therapy (8.7 versus 10.7 days, P = 0.39), sepsis-related ICU-admission rates (13% versus 18%, P = 0.56) and sepsis-related in-hospital mortality (7% versus 9%, P = 0.71) between intervention and control groups, respectively.ConclusionsAMS team intervention resulted in significant improvement in appropriateness of antimicrobial therapy following MET calls due to suspected sepsis. Targeted AMS review should be implemented to support early antimicrobial de-escalation and optimization in patients with suspected sepsis.
Highlights
Sepsis is a leading cause of death in hospitalized patients.[1]
While various sepsis campaigns have focused on early recognition and management, there is a concern that the imperative to administer rapid antimicrobials in septic patients may result in inappropriate antimicrobial use
The early administration of empirical antimicrobial therapy must be balanced with the unintended consequences of antimicrobial use, such as adverse drug effects, antimicrobial- or healthcare-associated infections (e.g. Clostridioides difficile infection) and the emergence of drug-resistant microorganisms
Summary
Sepsis is a leading cause of death in hospitalized patients.[1] To minimize this risk, early administration of appropriate antimicrobial therapy is required to reduce mortality.[2,3] While various sepsis campaigns have focused on early recognition and management, there is a concern that the imperative to administer rapid antimicrobials in septic patients may result in inappropriate antimicrobial use. The early administration of empirical antimicrobial therapy must be balanced with the unintended consequences of antimicrobial use, such as adverse drug effects, antimicrobial- or healthcare-associated infections (e.g. Clostridioides difficile infection) and the emergence of drug-resistant microorganisms. Antimicrobial resistance is a serious threat to global public health, with a rapidly increasing health and economic burden.[4] To balance this risk, guidelines stipulate that empirical antimicrobial therapy in sepsis should be reviewed and de-escalated when possible.[2,5]
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