Abstract
Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools.
Highlights
Sepsis, defined as dysregulated host response leading to life threatening organ dysfunction secondary to infection, has been thought to contribute significantly to in-hospital mortality [1,2]
Analysing only patients who received antibiotics, we found that 49.75% (300/603) had blood cultures, 13.81% (70/507) had sputum cultures, 35.47% (210/592) had urine cultures, 9.01% (53/588) had wound cultures and 13.42% (104/775) had other microbiological investigations
We found that patients who received antibiotics were more likely to have obtained blood and urine cultures in comparison to the patients with no antibiotic treatment (p < 0.0001 and p = 0.04, respectively)
Summary
Sepsis, defined as dysregulated host response leading to life threatening organ dysfunction secondary to infection, has been thought to contribute significantly to in-hospital mortality [1,2]. Recent data suggests that despite increased awareness of this condition, the incidence of sepsis in the last decade has remained high and its associated morbidity and mortality has increased. This is considered to be a consequence of ageing populations which are changing cohort characteristics to favour the admission of patients with lower physiological reserve [3]. The early administration of resuscitation bundles, including appropriate antibiotics, has been demonstrated to improve patient outcomes [4]. This has led to several national and international quality improvement initiatives. We have investigated the effectiveness of this approach previously in our series of point prevalence studies [8,9,10]
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