Scholarlink

Background <p>Sepsis is a life-threatening condition responsible for millions of deaths worldwide. Although mortality rates have declined, sepsis remains a major global health concern. Early recognition and prompt, appropriate treatment are essential for improving patient outcomes. However, implementing effective sepsis management protocols in Emergency Departments (EDs) is often hindered by staff shortages and high patient volumes. Strengthening sepsis care is also crucial for promoting responsible antibiotic use. This study aimed to evaluate the impact of an antimicrobial stewardship (AMS) program—based on stakeholder training, audit, and feedback—implemented in the ED on the management of sepsis.</p> Methods <p>A retrospective pre-post intervention analysis was conducted to assess changes in adherence to sepsis management guidelines and clinical outcomes following the introduction of the AMS program. The effect of the intervention on key process indicators was evaluated using Interrupted Time Series (ITS) analysis and logistic regression models adjusted for age and sex.</p> Results <p>We analysed data from 577 septic patients in the pre-intervention period and 502 in the post-intervention period. Following implementation, sepsis recognition increased from 47.5% to 61% (<i>p</i> &lt; 0.0001). Significant improvements were also observed in the collection of blood cultures (from 20.5% to 42.4%, <i>p</i> &lt; 0.0001), antibiotic administration (25.7% to 46.8%, <i>p</i> &lt; 0.0001), and crystalloid fluid administration (53% to 72%, <i>p</i> &lt; 0.0001). Complete execution of the sepsis treatment bundle increased substantially post-intervention (OR 2.99, <i>p</i> &lt; 0.0001). Adherence to institutional antibiotic guidelines also improved (OR 4.54, <i>p</i> &lt; 0.0001). ITS analysis confirmed improvements in all components of the sepsis bundle and in sepsis recognition after the intervention. Adherence to local antibiotic guidelines alone (OR 0.59, 95% CI 0.33–1.04) and in combination with sepsis recognition (OR 0.51, 95% CI 0.28–1.01) was associated with a reduction in 14-day mortality.</p> Conclusion <p>The AMS program led to substantial improvements in nearly all key process indicators for sepsis management, supporting the objectives of the WHO Global Action Plan on Antimicrobial Resistance, particularly in countries with high prevalence of multidrug-resistant bacteria (WHO. Global Action Plan on Antimicrobial Resistance; World Health Organization: Geneva, Switzerland; 2015). Process indicators were confirmed to be associated with improved short-term survival.</p> Clinical trial number <p>Not applicable.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Sepsis in the emergency department: a dual challenge of early management and antimicrobial stewardship

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年11月12日

查看全文
  • Romina Corsini,
  • Giulia Marini,
  • Marta Ottone,
  • Paolo Giorgi Rossi,
  • Ivana Maria Lattuada,
  • Valentina Cocchi,
  • Davide Maria Francesco Lucchesi,
  • Benedetta Cacciamani,
  • Sara Beneventi,
  • Samuele Cantergiani,
  • Federico Romani,
  • Mattia Simion,
  • Giuseppe Russello,
  • Sergio Mezzadri

摘要

Background

Sepsis is a life-threatening condition responsible for millions of deaths worldwide. Although mortality rates have declined, sepsis remains a major global health concern. Early recognition and prompt, appropriate treatment are essential for improving patient outcomes. However, implementing effective sepsis management protocols in Emergency Departments (EDs) is often hindered by staff shortages and high patient volumes. Strengthening sepsis care is also crucial for promoting responsible antibiotic use. This study aimed to evaluate the impact of an antimicrobial stewardship (AMS) program—based on stakeholder training, audit, and feedback—implemented in the ED on the management of sepsis.

Methods

A retrospective pre-post intervention analysis was conducted to assess changes in adherence to sepsis management guidelines and clinical outcomes following the introduction of the AMS program. The effect of the intervention on key process indicators was evaluated using Interrupted Time Series (ITS) analysis and logistic regression models adjusted for age and sex.

Results

We analysed data from 577 septic patients in the pre-intervention period and 502 in the post-intervention period. Following implementation, sepsis recognition increased from 47.5% to 61% (p < 0.0001). Significant improvements were also observed in the collection of blood cultures (from 20.5% to 42.4%, p < 0.0001), antibiotic administration (25.7% to 46.8%, p < 0.0001), and crystalloid fluid administration (53% to 72%, p < 0.0001). Complete execution of the sepsis treatment bundle increased substantially post-intervention (OR 2.99, p < 0.0001). Adherence to institutional antibiotic guidelines also improved (OR 4.54, p < 0.0001). ITS analysis confirmed improvements in all components of the sepsis bundle and in sepsis recognition after the intervention. Adherence to local antibiotic guidelines alone (OR 0.59, 95% CI 0.33–1.04) and in combination with sepsis recognition (OR 0.51, 95% CI 0.28–1.01) was associated with a reduction in 14-day mortality.

Conclusion

The AMS program led to substantial improvements in nearly all key process indicators for sepsis management, supporting the objectives of the WHO Global Action Plan on Antimicrobial Resistance, particularly in countries with high prevalence of multidrug-resistant bacteria (WHO. Global Action Plan on Antimicrobial Resistance; World Health Organization: Geneva, Switzerland; 2015). Process indicators were confirmed to be associated with improved short-term survival.

Clinical trial number

Not applicable.