Catheter-related Bacteremia Research Articles

Catheter-related bacteremia by Cupriavidus metallidurans

Cupriavidus bacteremia is a rare infection and identification of the pathogen is difficult. We present four cases of bacteremia by Cupriavidus metallidurans that were initially identified to the genus level by both Bruker and Vitek matrix-assisted laser desorption ionization–time of flight mass spectrometry and later identified to the species level by 16S rRNA gene sequencing. To our knowledge, these are the first cases of C. metallidurans catheter-related infections. Patients were successfully treated with antibiotic therapy and catheter removal.

Use of sodium hypochlorite for skin antisepsis before inserting a peripheral venous catheter: a pilot study.

Although it can be prevented, catheter-related bacteremia is common and dangerous. The antiseptics most widely used during insertion of peripheral venous catheters (PVCs) include povidone iodine, alcohol, and chlorhexidine. Another widely used antiseptic is a solution of 0.057 g sodium hypochlorite. This pilot study explored the contamination rate of the PVC tip inserted after skin decontamination with sodium hypochlorite. Culture analysis of the tips of the PVCs inserted into the 42 participants showed 7 (16.7%) colonized catheters. The results of this pilot study suggest taking into serious consideration the assessment of this antiseptic in randomized experimental studies.

Nosocomial extended-spectrum beta-lactamase-producing Klebsiella pneumoniae bacteremia in hemodialysis patients and the implications for antibiotic therapy

In the face of increasing treatment options for extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) hemodialysis (HD) access-related bacteremia, the difference in clinical effectiveness between ertapenem and flomoxef remains unclear. We conducted this retrospective study to determine their efficacies and treatment outcomes. Patients on maintenance HD with fistula-, graft-, or catheter-related ESBL-Kp bacteremia were enrolled. Data related to clinical features and antibiotic treatments were collected. Outcome was determined by mortality resulting from bacteremia during the 14-day period after the collection of the first positive blood culture for flomoxef-susceptible ESBL-Kp. The 64 patients studied had severe septicemia as determined by the Pitt bacteremia score; 50% (32/64) were in the intensive care unit (ICU) at the time of bacteremia. Old age (>65 years; 57.8%), malnutrition (albumin<3.5g/dl; 92.2%), a history of severe illnesses (defined by shock, intubation, or ICU stay; 82.5%), and prolonged hospitalization prior to the onset of bacteremia (>30 days; 75%) were also highly prevalent. The study population comprised nine fistula-, 10 graft-, and 45 HD catheter-related bacteremia cases, and the mortality rate was high (38/64, 59.4%). The mortality rate was significantly higher in the flomoxef treatment group than in the ertapenem treatment group (22/30, 73% vs. 16/34, 47%, p<0.05). Among patients with catheter-related bacteremia, multivariate analyses revealed that flomoxef use (odds ratio (OR) 2.52, 95% confidence interval (CI) 1.34-35.17) and Pitt bacteremia score (OR 4.37, 95% CI 1.28-5.26) were independently associated with mortality. In accordance with our previous study, our results have demonstrated the inferiority of flomoxef to carbapenems in the treatment of HD access-related ESBL-Kp bacteremia and provide an insight into the possibility of using ertapenem rather than flomoxef as an initial or de-escalating therapy for infections caused by ESBL-producing bacteria.

PP242-SUN: Impact of the Implementation of a Multidisciplinary Prevention Strategy in the Incidence of Catheter-Related Bacteremia due to Parenteral Nutrition (BRC-NP) in the HOSPITAL

PP242-SUN: Impact of the Implementation of a Multidisciplinary Prevention Strategy in the Incidence of Catheter-Related Bacteremia due to Parenteral Nutrition (BRC-NP) in the HOSPITAL

An economic evaluation of rt-PA locking solution in dialysis catheters.

In a recent randomized trial, weekly recombinant tissue plasminogen activator (rt-PA), 1 mg per lumen, once per week, and twice-weekly heparin as a locking solution (rt-PA/heparin) resulted in lower risks of hemodialysis catheter malfunction and catheter-related bacteremia compared with thrice-weekly heparin (heparin alone). We collected detailed costs within this trial to determine how choice of locking solution would affect overall health care costs, including the cost of locking solutions and all other relevant medical costs over the course of the 6-month trial. Nonparametric bootstrap estimates were used to derive 95% confidence intervals (CIs) and mean cost differences between the treatment groups. The cost of the locking solution was higher in patients receiving rt-PA/heparin, but this was partially offset by lower costs for managing complications. Overall, the difference in unadjusted mean cost for managing patients with rt-PA/heparin versus heparin alone was Can$323 (95% CI, -$935 to $1581; P=0.62). When the costs were extrapolated over a 1-year time horizon using decision analysis, assuming ongoing rt-PA effectiveness, the overall costs of the strategies were similar. This finding was sensitive to plausible variation in the frequency and cost of managing patients with catheter-related bacteremia, and whether the benefit of rt-PA on catheter-related bacteremia was maintained in the long term. In summary, we noted no significant difference in the mean overall cost of an rt-PA/heparin strategy as a locking solution for catheters compared with thrice-weekly heparin. Cost savings due to a lower risk of hospitalization for catheter-related bacteremia partially offset the increased cost of rt-PA.

Resultados de la aplicación del proyecto Bacteriemia Zero en Catalunya

The nationwide Bacteremia Zero (BZ) Project consists in the simultaneous implementation of measures to prevent central venous catheter-related bacteremia (CVC-B) in critically ill patients and in the development of an integral safety plan. The objective is to present the results obtained after the implementation of the BZ project in the ICUs of the Autonomous Community of Catalonia, Spain.All patients admitted to ICUs in Catalonia participating in the ENVIN-HELICS registry between January 2009 and June 2010 were included. Information was provided by 36 (92.3%) of the total possible 39 ICUs. A total of 281 episodes of CVC-B were diagnosed (overall rate of 2.53 episodes per 1000 days of CVC).The rates have varied significantly between ICUs that participated in the project for more or less than 12 months (2.17 vs. 4.27 episodes per 1000 days of CVC, respectively; p<.0001).The implementation of the BZ Project in Catalonia has been associated with a decrease greater than 40% in the CVC-B rates in the ICUs of this community, which is much higher than the initial objective of 4 episodes per 1000 days of CVC).

Initial and Extended Use of Femoral Versus Nonfemoral Double-Lumen Vascular Catheters and Catheter-Related Infection During Continuous Renal Replacement Therapy

The risk of catheter-related infection or bacteremia, with initial and extended use of femoral versus nonfemoral sites for double-lumen vascular catheters (DLVCs) during continuous renal replacement therapy (CRRT), is unclear. Retrospective observational cohort study. Critically ill patients on CRRT in a combined intensive care unit of a tertiary institution. Femoral versus nonfemoral venous DLVC placement. Catheter-related colonization (CRCOL) and bloodstream infection (CRBSI). CRCOL/CRBSI rates expressed per 1,000 catheter-days. We studied 458 patients (median age, 65 years; 60% males) and 647 DLVCs. Of 405 single-site only DLVC users, 82% versus 18% received exclusively 419 femoral versus 82 jugular or subclavian DLVCs, respectively. The corresponding DLVC indwelling duration was 6±4 versus 7±5 days (P=0.03). Corresponding CRCOL and CRBSI rates (per 1,000 catheter-days) were 9.7 versus 8.8 events (P=0.8) and 1.2 versus 3.5 events (P=0.3), respectively. Overall, 96 patients with extended CRRT received femoral-site insertion first with subsequent site change, including 53 femoral guidewire exchanges, 53 new femoral venipunctures, and 47 new jugular/subclavian sites. CRCOL and CRBSI rates were similar for all such approaches (P=0.7 and P=0.9, respectively). On multivariate analysis, CRCOL risk was higher in patients older than 65 years and weighing >90kg (ORs of 2.1 and 2.2, respectively; P<0.05). This association between higher weight and greater CRCOL risk was significant for femoral DLVCs, but not for nonfemoral sites. Other covariates, including initial or specific DLVC site, guidewire exchange versus new venipuncture, and primary versus secondary DLVC placement, did not significantly affect CRCOL rates. Nonrandomized retrospective design and single-center evaluation. CRCOL and CRBSI rates in patients on CRRT are low and not influenced significantly by initial or serial femoral catheterizations with guidewire exchange or new venipuncture. CRCOL risk is higher in older and heavier patients, the latter especially so with femoral sites.

Consumer Moments of Truth In the Digital Context

Optimizing vascular access outcomes remains an ongoing challenge for clinical nephrologists. All other things being equal, fistulas are preferred over grafts, and grafts are preferred over catheters. Mature fistulas have better longevity and require fewer interventions, as compared with mature grafts. The major hurdle to increasing fistula use is the high rate of failure to mature of newly created fistulas. There is a desperate need for enhanced understanding of the mechanisms of failure to mature and the optimal type and timing of interventions to promote maturity. Grafts are prone to frequent stenosis and thrombosis. Surveillance for graft stenosis with preemptive angioplasty may reduce graft thrombosis, but recent randomized clinical trials have questioned the efficacy of this approach. Graft stenosis results from aggressive neointimal hyperplasia, and pharmacologic approaches to slowing this process are being investigated in clinical trials. Catheters are prone to frequent thrombosis and infection. The optimal management of catheter-related bacteremia is a subject of ongoing debate. Prophylaxis of catheter-related bacteremia continues to generate important clinical research. Close collaboration among nephrologists, surgeons, radiologists, and the dialysis staff is required to optimize vascular access outcomes and can be expedited by having a dedicated access coordinator to streamline the process. The goal of this review is to provide an update on the current status of vascular access management.

Systematic review and meta-analysis on management of hemodialysis catheter-related bacteremia.

Hemodialysis catheter-related bacteremia is a common clinical problem with several management options. We performed a systematic review and meta-analysis to determine cure proportions with systemic antibiotics, antibiotic lock solution, and guidewire exchange. We searched databases and registries; conference proceedings from relevant medical societies; and article reference lists. Data regarding management approach, cure, follow-up, recurrence, complications, and microbiology were abstracted and pooled from 28 selected publications. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated from a mixed effects logistic regression model. In total, 1596 patients with tunneled hemodialysis catheter-related bacteremia were divided into groups on the basis of treatment with systemic antibiotics (n=697), antibiotic lock solution (n=546), or guidewire exchange (n=353). Antibiotic lock solution and guidewire exchange had similar cure proportions that were superior to systemic antibiotics alone (OR, 2.08; 95% CI, 1.25 to 3.45; P<0.01 for antibiotic lock solution; OR, 2.88; 95% CI, 1.82 to 4.55; P<0.001 for guidewire exchange versus systemic antibiotics). Cure proportions were highest for coagulase-negative staphylococci followed by gram-negative rods and Staphylococcus aureus. Among S. aureus infections, guidewire exchange led to a higher cure proportion than systemic antibiotics or antibiotic lock solution (OR, 3.33; 95% CI, 1.17 to 9.46; P=0.02; OR, 4.72; 95% CI, 1.79 to 12.46; P=0.002, respectively). Thus, results of this study suggest that tunneled hemodialysis catheter-related bacteremia should be treated with either guidewire exchange or antibiotic lock solution. Future studies should address prospectively whether one strategy is better than the other overall and for specific pathogens.

Bacteremia caused by an Acinetobacter junii strain harboring class 1 integron and diverse DNA mobile elements

Infections caused by Acinetobacter junii are rarely reported. However, some outbreaks of septicemia in neonates and pediatric oncology patients, as well as meningitis, peritonitis, and ocular infection have been described. Since it is highly infrequent to find the molecular characterization of A. junii strains in literature, in this study we described the molecular characterization of A. junii isolates recovered from blood samples of a renal transplant patient. The case was defined as a catheter-related bacteremia caused by A. junii. The patient responded favorably after catheter removal and treatment with ciprofloxacin. The complete molecular characterization of the isolate showed that it harbored a class 1 integron and diverse DNA mobile elements. This explains its genomic plasticity for acquiring antimicrobial resistance determinants and for adapting to a nosocomial niche.

Diagnostic Usefulness of Differential Time to Positivity for Catheter-Related Candidemia

A differential time to positivity (DTP) of ≥ 120 min is useful for diagnosing catheter-related bacteremia, but data on diagnosing catheter-related candidemia (CRC) in this way are limited. We wished to evaluate the usefulness of the DTP for diagnosing CRC. All adult patients who had the same Candida species isolated from blood cultures drawn simultaneously from a central venous catheter (CVC) and a peripheral vein were included at a tertiary care hospital over an 18-month period. A total of 105 patients with candidemia who had positive simultaneous CVC and peripheral vein blood cultures were included in our study. Sixty-one patients (58%) had CRC (47 definite and 14 probable), and 38 (36%) had candidemia from another source (non-CRC). The remaining 6 patients (6%) with indeterminate candidemia were excluded from the final analysis. The overall sensitivity and specificity of a DTP of ≥ 120 min for diagnosing CRC were 85% (95% confidence interval [CI], 74% to 93%) and 82% (95% CI, 66% to 92%), respectively, and for neutropenic patients, they were 75% (95% CI, 19% to 99%) and 100% (95% CI, 75% to 100%), respectively. For Candida glabrata infections, the optimal DTP cutoff was ≥ 6 h, with a sensitivity of 63% (95% CI, 35% to 85%) and a specificity of 75% (95% CI, 35% to 97%). In summary, DTP is useful for diagnosing CRC, and a DTP of ≥ 120 min appears to be the optimal cutoff except for CRC caused by C. glabrata. For neutropenic patients, DTP may be useful as an adjunct test to rule in CRC and to decide whether a catheter should be removed.

Preventing Catheter-Related Bacteremia with Taurolidine-Citrate Catheter Locks: A Systematic Review and Meta-Analysis

Background: Preliminary evidence from some studies suggests that taurolidine-citrate locks decrease catheter-related bacteremia (CRB), which is a major cause of morbidity and mortality in patients using intravascular catheters. No previous study has sought to summarize existing evidence on the use of taurolidine-citrate locks. A systematic review and meta-analysis were undertaken to determine whether taurolidine-citrate was more effective than heparin in the prevention of CRB. Methods: The major English (PubMed, EBSCO, Web of Science and OVID) and Chinese (CBM, CNKI, VIP and Wanfang Data) healthcare databases were searched for randomized controlled trials comparing the efficacy and safety of taurolidine-citrate lock solution (TCLS) and heparin lock solution in the prevention of CRB. Results: Three studies involving 236 patients with a total of 34,984 catheter days were included. The use of TCLS significantly decreased the risk of CRB (relative risk = 0.47, 95% CI: 0.25-0.89) and Gram-negative bacterial infection. There was no significant difference in Gram-positive infections and exit-site infections. Conclusions: Catheter locking with TCLS reduced the risk of CRB and Gram-negative bacterial infection. Adverse events include thrombotic events.

Evaluation of infections in geriatric patients at intensive care unit

Background: Infection is a major problem among hospitalized geriatric patients due to reduced immune functions and comorbidities. The course of infections seen in this group are more serious than young people. Duration of hospitalization, morbidity and mortality rates are high. The aim of this study is to evaluate geriatric infections and infection agents in geriatric patients. Methods & Materials: The study was performed in January 2012–December 2012 for one year at Izmir Tepecik Education and Research Hospital. Infections and causative agents among hospitalized patients over 65 years old at Anaesthesiology and Reanimation Intensive Care Unit were evaluated, retrospectively. Data of the patients was achieved from the infection control comitee records. Results: A total of 294 patients were followed-up at intensive care unit during study period. One hundred and seventy six patients (60.8%) who were over 65 years old, enrolled into the study. Infection was detected in 77 (43.7%) of the geriatric patients. The most common infection was ventilatory associated pneumonia (68.8%), following urinary tract infection (32.4%), primary bacteremia (31.3%), catheter related bacteremia (11.6%), pneumonia (6.4%) and skin and soft tissue infections (5.1%). In deep tracheal aspirate cultures, 104 microorganism were isolated. The most common isolated microorganisms were A. baumannii (39.4%) and P. aeruginosa (28.8%). In 35 positive urine cultures, E.coli and P. aeruginosa were both the most prevalent bacterias (20%). The most common primary bacteremia agents were coagulase negative staphylococci (26.9%), A. baumannii (19.2%), E. faecium (15.3%). A. baumannii (30%) was the major cause of catheter related bacteremia. Sputum culture yielded P. aeruginosa (54.5%) and A. baumannii (27.2%) mostly in patient with pneumonia. Tissue biopsy cultures revealed seven (42.8%) isolates of K. pneumoniae. Conclusion: Hospital-acquired infections are major health problem in geriatric patients especially in intensive care units. Cause of infections are predominantly polymicrobial resistant agents such as A. baumannii and P. aeruginosa. Judicious use of antibiotics, limitation of invasive instruments, applying infection control measures can reduce the morbidity and mortality due to infections

Characteristics of biofilms formed on non-tunneled hemodialysis catheters

BackgroundMicrobial biofilms are mechanisms used by microorganisms that cause chronic infections in humans. In hemodialysis patients with catheter-related bacteremia, Staphylococcus aureus is an independent risk factor for both infectious complications and failure of bacteremia treatment. We analyzed the characteristics of biofilms formed by these Staphylococcus species on non-tunneled hemodialysis catheters. Patients and methodsA total of 50 adult patients with end-stage renal disease receiving hemodialysis through non-tunneled catheters, whose catheters were removed for catheter-related bacteremia, were studied. ResultsCatheter cultures were positive in only 32 patients and staphylococcal biofilm was found in 25 patients. All biofilm producers were S. aureus. In tissue culture plate method, 2 were strong biofilm producers, 15 were moderate biofilm producers and 5 isolates were considered as weak biofilm producers. In tube method, there were no strong biofilm producers, 12 were moderate biofilm producers and 13 were weak biofilm producers. In Congo red agar method there were no strong biofilm producers, 10 were moderate biofilm producers and 15 isolates were weak biofilm producers. ConclusionOur study shows that S. aureus is the most common bacteria isolated from patients with catheter-related bacteremia. S. aureus is the predominant microorganism responsible for biofilm formation in the non-tunneled HD catheters. Tissue culture plate method is more sensitive to detect biofilm formation by S. aureus.

Comparison of Tesio and LifeCath Twin Permanent Hemodialysis Catheters: The VyTes Randomized Trial

Central venous catheters for maintenance hemodialysis (HD) are designed to attain the required dialysis dose through sustained high blood flow rates (BFR). The authors studied the immediate and long-term performance and complications of two twin-catheter systems, the Tesio catheter (TC) and the LifeCath Twin (LC), to inform clinical practice. This single-center randomized controlled parallel-group trial allocated 80 incident patients (1:1) to receive either a TC (MedComp) or LC (Vygon). Patients were dialyzed to target BFR 450 mL/min and followed up for 12 months. The primary outcome was achievement of target BFR during the first HD session. Secondary outcomes included thrombotic dysfunction, displacement and catheter-related infection. Catheter dysfunction was defined by a BFR ≤ 250 mL/min. More LCs reached the primary endpoint (44% vs. 10%, p=0.001) delivering a higher BFR (mean 383±82 vs. 277±79 mL/min, p<0.001). Significant differences in BFR persisted until the fourth dialysis session. Rates of catheter-related bacteremia (0.40 vs. 0.51/1,000 catheter days, p=0.7) and exit site infection were similar between groups (0.24 vs. 0.09/1,000 catheter days, p=0.4). Overall rates of catheter dysfunction were 2.8/1,000 catheter days (95% CI 2.1-3.5), with no differences in thrombolytic lock use although the LC group required more thrombolytic infusions (6 vs. 0, p=0.01). The LC can deliver greater BFRs in the first three HD sessions following insertion although this did not translate into differences in performance, dialysis adequacy or complication rates with long-term use. Both catheter types can consistently deliver high BFRs over an extended period of time.

Doit-on utiliser la décontamination cutanée par la chlorhexidine en réanimation ?

Prevention of health care-associated infection is a major concern in the intensive care unit. Bacterial skin colonization often precedes occurrence of these infections, especially infections related to staphylococcus species. Chlorhexidine is a topical bactericidal antiseptic with a good antimicrobial activity against Gram positive cocci, fungi but a limited activity against Gram negative rods. Daily chlorhexidine bathing may reduce the occurrence of nosocomial infection by decreasing skin bacterial load. The first observational studies have reported a decrease in skin colonization with staphylococcal or enterococcal species. A decrease in the rate of catheter-related bacteremia and primitive bacteremia has been also described. Multicenter randomized studies have reported a lower incidence of bacteremia caused by coagulase-negative staphylococci. Chlorhexidine bathing was not associated with a lower occurrence of ventilator-associated pneumonia and nosocomial urinary tract infections. This procedure was not associated with a lower incidence of infections caused by Gram negative bacilli. If the use of chlorhexidine bathing for a few months was not associated with acquisition of resistance, increase in the minimal inhibitory concentrations has been described for staphylococci. Daily chlorhexidine bathing could be recommended in units where incidence of staphylococcal blood stream infections remains high.

Sacroiliitis secondary to catheter-related bacteremia due to Mycobacterium abscessus (sensu stricto)

We describe a case of sacroiliitis secondary to catheter-related bacteremia due to Mycobacterium abscessus (sensu stricto). This case confirms that MultiLocus sequence typing and variable-number tandem-repeat methods are very robust techniques to identify the pathogen species and to validate molecular epidemiological links among complex M. abscessus isolates.

Tigecycline therapy for infections due to carbapenemase-producing Klebsiella pneumoniae in critically ill patients

The aim of this study was to assess the efficacy of tigecycline in the treatment of infections due to carbapenemase-producing Klebsiella pneumoniae (CPKP) in critically ill patients. A retrospective observational study was conducted in critically ill patients receiving different tigecycline doses for severe CPKP infections. We evaluated demographic data, localization and severity of infection, response to therapy, and mortality. Fifteen patients received tigecycline for 16 episodes of CPKP infection. The main infections were pneumonia (31%), urinary tract infection (31%), peritonitis (20%), catheter-related bacteraemia (12%), and meningitis (6%). Most infections were complicated with severe sepsis (44%), septic shock (12%), and/or bacteraemia (19%). The daily maintenance dose of tigecycline was 200 mg in 10 episodes and 100 mg in 6 episodes. The overall 30-day mortality rate was 25%. Univariate analysis showed that mortality was significantly associated (p < 0.01) with mean APACHE II and SOFA scores and the presence of immunosuppression, but not with the tigecycline dose. Tigecycline appears to be an effective therapy for severe infections due to CPKP in critically ill patients. Mortality is related to the severity of the underlying disease. We observed no benefit from a higher maintenance dose of tigecycline, although the number of patients included in the study was too small to draw any general conclusions in this regard.

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Introduction: Carbapenem resistance is increasing and correlates with worsened outcomes. Unfortunately, patients with carbapenem-resistant gram-negative infections rarely receive appropriate empiric therapy despite an association of early appropriate antimicrobials with improved mortality and morbidity in critically ill patients with septic shock. However, there is limited data on the impact of early appropriate antibiotics and mortality with carbapenem resistance. Methods: Adult patients admitted to an ICU with sepsis due to gram-negative bacteremia resistant to a carbapenem were included. Exclusion criteria included polymicrobial, recurrent, or breakthrough infections, or patients who expired before appropriate antibiotics were initiated. Patients were divided into those alive or deceased at 30 days after index culture. Classification and regression tree analysis (CART) was used to determine the breakpoint between early and delayed treatment. Independent factors associated with mortality were identified through multivariate logistic regression. Results: Of 115 patients included, there were 69 (60%) survivors and 46 (40%) non-survivors at day 30. Baseline criteria were similar except non-survivors were older (63.9 vs. 55.7 years, P=0.003) and had higher Sequential Organ Failure Assessment (SOFA) (11.7 vs. 9.7, P=0.009) and Charlson Comorbidity Index scores (5.4 vs. 3.9, P=0.02). Non-survivors were more likely to have catheter-related bacteremia (52.2 vs. 29%, P=0.012) and less likely to have bacteremia from a urinary tract source (4.2 vs. 30.4%, P=0.001). Type of organism, overall source of infection, first appropriate antibiotic, and use of combination therapy did not affect mortality. The CART-established breakpoint for early antibiotics was 0.8 hour (mortality 0%, <0.8 hour vs. 42%, >0.8 hour, P=0.082). On logistic regression, only age (OR 1.037, 95% CI: 1.004-1.071, P=0.027) and SOFA score (OR 1.165, 95% CI: 1.033-1.314, P=0.013) were independently associated with mortality. Early appropriate antibiotic use was not independently associated with mortality on multivariate analysis. Conclusions: Older age and higher SOFA score were independent risk factors for 30-day mortality. Early appropriate antibiotics was not associated with mortality.

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Introduction: Early quantitative resuscitation for sepsis can reduce mortality significantly, therefore early identification and treatment is imperative to improving outcomes. Sepsis is a common cause for clinical deterioration in the admitted patient, and is one of the most common diagnoses identified by Rapid Response Teams (RRTs). Our goal was to determine the accuracy of sepsis recognition and the appropriateness of treatment initiated by the RRT for patients who developed sepsis on the inpatient ward. Methods: Retrospective review of a prospectively collected quality improvement database from January 31, 2012 to February 28, 2013. Descriptive statistics were used in data analysis. Results: 36 patients were identified as septic by the RRT. Patients were 66% male and the average age was 51 years. 92% met SIRS criteria, 11% were in shock, 44% were culture positive, with 28% having positive blood cultures. Overall mortality was 11%. Infectious source was most frequently pulmonary (46%), followed by unknown (18%), urine (14%), catheter-related (11%), abdomen (7%), and primary bacteremia (4%). RRT accuracy in diagnosing sepsis was 78%. The RRT initiated treatment with fluids, antipyretics/cooling, and/or antibiotics in 71% of cases. Blood or urine cultures were sent 69% of the time and additional antibiotics were started 53% of the time with an average time to antibiotics of 180 minutes. Adequate fluid resuscitation (20 ml/kg) was administered only 29% of the time. Conclusions: RRTs can accurately identify and initiate treatment of admitted patients with sepsis. Additional improvement can be made by increasing the quantity of resuscitative fluid, increasing the proportion of patients treated with antibiotics, and reducing time to antibiotics.