A multifaceted educational intervention shortened time to antibiotic administration in children with severe sepsis and septic shock: ABISS Edusepsis pediatric study

Esteban, Elisabeth; Belda, Sylvia; García-Soler, Patricia; Rodrı́guez-Núñez, Antonio; Calvo, Cristina; Gil-Antón, Javier; Bustinza, Amaya; Iglesias-Bouzas, María Isabel; Pujol-Jove, Montserrat; deCarlos, Juan Carlos; Íñiguez, J.P. García; Pérez-Iranzo, Antonio; Téllez, Cinta; Ortiz, Irene; Pérez, R; Bonil, Vanesa; Brió, Sònia; Concha, Andrés; López, J. Alcalde; Murga, Vega; Flores, J. M.; Trujillo, Alberto; Felipe, Aida; Abadesso, Clara; Pino, María; Leon, J.; Martínez, M Zapatero; Gómez, Fernando Fernández; Pérez-Montejano, Rut; Tapia, Rocío; Jordán, Iolanda; Ferrer, Ricard

doi:10.1007/s00134-017-4721-4

Cited by 16 publications

(12 citation statements)

References 5 publications

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“…Multifaceted educational interventions have also been shown to shorten delays in antibiotic administration in children with SS when using workshops, meetings, posters, leaflets, email reminders, and online training simulation ( 21 ). In addition, recent studies at The Children’s Hospital of Philadelphia showed that algorithmic alerts integrated in the EMR based on vital-signs and high risk conditions in conjunction with serial physician judgment and “sepsis huddles” tend to produce the best sensitivity and specificity for SS (96.6–99.4% sensitivity and 83.3–99.1% specificity) encouraging the use of both staff training in conjunction with EMR alerts ( 22 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

et al. 2018

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ObjectivesThis study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER) of a tertiary care children’s hospital.MethodsThis was a retrospective, observational study of children (0–18 years old) in The Children’s Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9) diagnostic codes for “severe sepsis” and “shocks.” Patients in the adherent group were those who met all three elements of adherence: (1) rapid vascular access with at most one IV attempt before seeking alternate access (unless already in place), (2) fluids administered within 15 min from sepsis recognition, and (3) antibiotic administration started within 1 h of sepsis recognition. Comparisons between groups with and without sepsis guideline adherence were performed using Student’s t-test (the measurements expressed as median values). The proportions were compared using chi-square test. p-Value ≤0.05 was considered significant.ResultsA total of 43 patients who visited the ER from July 2014 to July 2015 had clinically proven severe sepsis or SS ICD-9 codes. The median age was 5 years. The median triage time, times from triage to vascular access, fluid administration and antibiotic administration were 26, 48.5, 76, and 135 min, respectively. Adherence to vascular access, fluid, and antibiotic administration guidelines was 21, 26, and 34%, respectively. Appropriate fluid bolus (20 ml/kg over 15–20 min) was only seen in 6% of patients in the non-adherent group versus 38% in the adherent group (p = 0.01). All of the patients in the non-adherent group used an infusion pump for fluid resuscitation. Hypotension and ≥3 organ dysfunction were more commonly observed in patients in adherent group as compared to patients in non-adherent group (38 vs. 14% p = 0.24; 63 vs. 23% p = 0.03).ConclusionOverall adherence to sepsis guidelines was low. The factors associated with non-adherence to sepsis guidelines were >1 attempt at vascular access, delay in antibiotic ordering, fluid administration using infusion pump, absence of hypotension, and absence of three or more organs in dysfunction at ER presentation.

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Section: Discussionmentioning

confidence: 99%

Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

et al. 2018

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“…Several studies have shown that bundle care is associated with better outcomes. [8][9][10][11][12] However, this evidence leads to controversial in-adherence to the 2016 SSC and bundles, taken by some organizations in the United States as mandatory policies. 7,8,13 Observational studies evaluating SSC bundle compliance have shown significant benefits in improving the timing of crucial interventions for mortality reduction in sepsis.…”

Section: Evidence On the Implementation Of The Ssc Guidelines Implementation Of The Ssc Bundles In Real Lifementioning

confidence: 99%

“…Quality improvement educational programs comprehend a different strategy from mandated sepsis care endorsing standard-of-care interventions that improve survival. 10,12 Thus, all clinicians should be trained to perform initial skilled interventions while waiting for a confirmed diagnosis and definitive treatment. The SSC guidelines (scientific evidence) and bundles (implementation strategy of guidelines) provide an education framework for the less experienced.…”

Section: Evidence On the Implementation Of The Ssc Guidelines Implementation Of The Ssc Bundles In Real Lifementioning

confidence: 99%

Evidence for the Application of Sepsis Bundles in 2021

Plata-Menchaca

Ruiz‐Rodríguez

Ferrer

2021

Semin Respir Crit Care Med

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Sepsis represents a severe condition that predisposes patients to a high risk of death if its progression is not ended. As with other time-dependent conditions, the performance of determinant interventions has led to significant survival benefits and quality-of-care improvements in acute emergency care. Thus, the initial interventions in sepsis are a cornerstone for prognosis in most patients. Even though the evidence supporting the hour-1 bundle is perfectible, real-life application of thoughtful and organized sepsis care has improved survival and quality of care in settings promoting compliance to evidence-based treatments. Current evidence for implementing the Surviving Sepsis Campaign bundles for early sepsis management is moving forward to better approaches as more substantial evidence evolves.

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“…Some of them include educational programs to promote de-escalation among professionals, novel microorganism identification techniques, and the use of biomarkers to guide decisions. Several initiatives promoting streamlining of antimicrobial therapy have been implemented to increase the frequency of antibiotic deescalation (65,104). In the ABISS-Edusepsis study, which included 2628 adult patients in 72 ICUs, the proportion of patients who had de-escalation increased significantly from 16.3% to 20.1% after an educational intervention consisting of a multifaceted educational program on sepsis care (65).…”

Section: De-escalation Of Antimicrobial Therapymentioning

confidence: 99%

An approach to antibiotic treatment in patients with sepsis

Martínez¹,

Plata-Menchaca²,

Ruiz‐Rodríguez³

et al. 2020

J Thorac Dis

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Sepsis is a medical emergency and life-threatening condition due to a dysregulated host response to infection, which is time-dependent and associated with unacceptably high mortality. Thus, when treating suspicious or confirmed cases of sepsis, clinicians must initiate broad-spectrum antimicrobials within the first hour of diagnosis. Optimizing antibiotic use is essential to ensure successful outcomes and to reduce adverse antibiotic effects, as well as preventing drug resistance. All likely pathogens involved should be considered to provide an appropriate antibiotic coverage. Clinicians must investigate on the previous risk of multidrug-resistant (MDR) pathogens, and the principle of individualized dosing should replace the principle of standard dosing. The loading dose is an initial higher dose of an antibiotic for all patients, yet an individualized treatment approach for further doses should be implemented according to pharmacokinetics (PK)/pharmacodynamics (PD) and the presence of renal/liver dysfunction. Extended or continuous infusion of beta-lactams and therapeutic drug monitoring (TDM) can help to achieve therapeutic levels of antimicrobials. Reevaluation of duration and appropriateness of treatment at regular intervals are also necessary. De-escalation and shortened courses of antimicrobials must be considered for most patients, except in some justified circumstances. 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.

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A multifaceted educational intervention shortened time to antibiotic administration in children with severe sepsis and septic shock: ABISS Edusepsis pediatric study

Cited by 16 publications

References 5 publications

Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

Evidence for the Application of Sepsis Bundles in 2021

An approach to antibiotic treatment in patients with sepsis

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