Antimicrobial Stewardship in Sepsis - References | Michigan Hospital Medicine Safety Consortium

References

Burston, J. et al. A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways: A Prospective Interventional Study.Infect Control Hosp Epidemiol 2017.

Sepsis overdiagnosis and delayed antibiotic optimization may reduce sepsis pathway effectiveness. Early antimicrobial stewardship efforts by Infectious Diseases improved antibiotic management of non-ICU inpatients with suspected sepsis, predominantly by de-escalation.

De Waele, J.J. et al. Antibiotic stewardship in sepsis management: toward a balanced use of antibiotics for the severely ill patient. Expert Rev Anti Infect Ther 2019.

Integrating AMS strategies in clinical practice can help upholding the best antibiotic empirical therapy while reducing antibiotic consumption. AMS is a multidisciplinary policy and should be embraced by critical care physicians as a solution for balanced antibiotic use.

Madaline, T. et al. Early infectious disease consultation is associated with lower mortality in patients with severe sepsis or septic shock who complete the 3-hour sepsis treatment bundle.Open Forum ID 2019.

Among patients who received the severe sepsis or septic shock bundle, early consultation by infectious disease was associated with a 40% reduction in risk for in-hospital mortality and a trend toward shorter time to antibiotic de-escalation.

Martinez, M.L. et al. An approach to antibiotic treatment in patients with sepsis. Journ Thoracic Dis 2020.

Leadership, teamwork, antimicrobial stewardship(AS) frameworks, guideline’s recommendations on the optimal duration of treatments, de-escalation, and novel diagnostic stewardship approaches will help us to improve patients’ quality of care.

Rashidzada, Z. et al. Early antimicrobial stewardship team intervention on appropriateness of antimicrobial therapy in suspected sepsis: A randomized controlled trial. JAC-Antimicrobial Resistance 2021.

A randomized controlled trial of an antimicrobial stewardship team intervention involving a review of antimicrobial therapies 48 hours after a Medical Emergency team call for suspected sepsis vs. no intervention. Those who received a review of medications by the stewardship team had significant improvement in appropriateness of antimicrobial therapy.

Rhee, C. et al. Prevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated with Inadequate and Broad-Spectrum Empiric Antibiotic Use.JAMA Netw Open 2020.

In this study, most patients with community-onset sepsis did not have resistant pathogens, yet broad-spectrum antibiotics were frequently administered. Both inadequate and unnecessarily broad empiric antibiotics were associated with higher mortality. These findings underscore the need for better tests to rapidly identify patients with resistant pathogens and for more judicious use of broad-spectrum antibiotics for empiric sepsis treatment.

Royer, S. et al. Shorter vs. Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta-Analysis. Journ of Hosp Med 2018.

Based on the available literature, shorter courses of antibiotics can be safely utilized in hospitalized patients with common infections, including pneumonia, urinary tract infection, and intra-abdominal infection, to achieve clinical and microbiological resolution without adverse events on mortality or recurrence.

Strich, J.R. et al. Considerations for empiric antimicrobial therapy in sepsis and septic shock in an era of antimicrobial resistance. J Infect Dis 2020.

Patients with sepsis present across a spectrum of infection sites and severity of illnesses requiring complex decision making at the bedside as to when prompt antibiotics are indicated and which regimen is warranted. The precise empiric regimen is determined by assessing patient and epidemiological risk factors, likely source of infection based on presenting signs and symptoms, and severity of illness. Hospitals should implement quality improvement measures to aid in the rapid and accurate diagnosis of patients with sepsis and to ensure antibiotics are given to patients in an expedited fashion after antibiotic order.

Teshome, B.F. et al. Duration Exposure to Antipseudomonal Beta-Lactam Antibiotics in the Critically Ill and Development of New Resistance. Journ Human Pharm & Drug Ther 2018.

Among critically ill patients who receive antipseudomonal beta-lactam antibiotics, each additional day of exposure to cefepime, meropenem, and piperacillin-tazobactam is associated with an increased risk of new resistance development.

Vaughn, V. et al. Thoughtless design of the electronic health record drives overuse, but purposeful design can nudge improved patient care.BMJ Qual & Saf 2018.

A critical step in improving clinician behavior is recognizing that most decisions occur with little active deliberation. When making rapid choices, clinicians are being influenced by EHR design, defaults, diagnostic stimuli, emotion, and social norms – whether purposeful or not. To improve, we must recognize these tendencies and use thoughtful design to capitalize on the potential of the EHR to improve patient care.

Wunderink, R.G. et al. Antibiotic Stewardship in the Intensive Care Unit. An Official American Thoracic Society Workgroup Report in Collaboration with the AACN, CHEST, CDC, and SCCM. ATS 2020.

Report of the findings of a workshop convened to address barriers to antibiotic stewardship in the ICU and discuss tactics to overcome these. The recommendation is for antibiotic stewardship should be a core competency of critical care practitioners, and training programs and continuing medical education are needed to address and assess this skill.