Antimicrobial Stewardship in the Management of Sepsis

Pulia, Michael S.; Redwood, Robert; Sharp, Brian

doi:10.1016/j.emc.2016.09.007

Cited by 20 publications

(17 citation statements)

References 118 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Guidelines specific to individual categories of patients with sepsis are informed by research conducted in well-resourced countries, and may not be practically applicable in low resource areas such as Uganda, in which comorbid conditions are strongly associated with sepsis (Borloz & Hamden, 2017;Pulia et al, 2017;Schultz et al, 2017). Currently, there is little support and motivation for the use and implementation of evidence-based practice in Uganda.…”

Section: Resultsmentioning

confidence: 99%

“…Currently, there is little support and motivation for the use and implementation of evidence-based practice in Uganda. Improving sepsis treatment is particularly challenging due to the increased antibiotic drug resistance contributed by the less effective management on antibiotic prescription practices (Borloz & Hamden, 2017;Kiguba et al, 2016, Mbonye et al, 2016Pulia et al, 2017;Sekikubo et al, 2017). Despite the fact, efforts made through nursing care may strengthen sepsis management and improve outcomes of patients with sepsis.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Examining nursing practices for management of sepsis in low income countries: the case of Uganda

Aliga¹,

Mutyabule²,

Nakate³

et al. 2018

Connect

View full text Add to dashboard Cite

Examining nursing practice guidelines to improve quality of care for patients with sepsis in low income countries is required. • A large amount of information about best practice standards in sepsis management is available for healthcare professionals; however, implementation and adherence to practice guidelines recommended by the Surviving Sepsis Campaign remains low in low income countries. • A formal scope of practice for nursing and midwifery as a professional guideline is absent and national clinical guideline for Uganda remains unclear regarding the specific management of sepsis. • Inadequate documentation of patient care in Uganda makes sepsis cases difficult to be early detected. • Research evidence regarding sepsis management remains scarce in Uganda. Adopting SSC guidelines without appropriate adaptation for the local context contributes problems, especially in LICs where necessary resources are limited.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Examining nursing practices for management of sepsis in low income countries: the case of Uganda

Aliga¹,

Mutyabule²,

Nakate³

et al. 2018

Connect

View full text Add to dashboard Cite

show abstract

“…For the purposes of this analysis, the 15% of patients who met 2 of 4 systemic inflammatory response syndrome (SIRS) [ 15 ] criteria or 2 of 3 quick Sepsis Related Organ Failure Assessment (qSOFA) [ 16 ] criteria were considered septic regardless of prescription setting. Although there is ongoing controversy about the optimal criteria for early sepsis determination, SIRS is currently utilized in the Centers for Medicare and Medicaid Services (CMS) quality reporting measure, SEP-1, which mandates antibiotic administration within 3 h of a patient meeting severe sepsis criteria in the ED [ 17 ]. Without access to additional clinical records to enable a more definitive determination about the presence of sepsis, all antibiotic starts that met these definitions of sepsis were characterized as appropriate.…”

Section: Methodsmentioning

confidence: 99%

Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis

Pulia

Kern

Schwei

et al. 2018

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

BackgroundThe pervasive, often inappropriate, use of antibiotics in healthcare settings has been identified as a major public health threat due to the resultant widespread emergence of antibiotic resistant bacteria. In nursing homes (NH), as many as two-thirds of residents receive antibiotics each year and up to 75% of these are estimated to be inappropriate. The objective of this study was to characterize antibiotic therapy for NH residents and compare appropriateness based on setting of prescription initiation.MethodsThis was a retrospective, cross-sectional multi-center study that occurred in five NHs in southern Wisconsin between January 2013 and September 2014. All NH residents with an antibiotic prescribing events for suspected lower respiratory tract infections (LRTI), skin and soft tissue infections (SSTI), and urinary tract infections (UTI), initiated in-facility, from an emergency department (ED), or an outpatient clinic were included in this sample. We assessed appropriateness of antibiotic prescribing using the Loeb criteria based on documentation available in the NH medical record or transfer documents. We compared appropriateness by setting and infection type using the Chi-square test and estimated associations of demographic and clinical variables with inappropriate antibiotic prescribing using logistic regression.ResultsAmong 735 antibiotic starts, 640 (87.1%) were initiated in the NH as opposed to 61 (8.3%) in the outpatient clinic and 34 (4.6%) in the ED. Inappropriate antibiotic prescribing for urinary tract infections differed significantly by setting: NHs (55.9%), ED (73.3%), and outpatient clinic (80.8%), P = .023. Regardless of infection type, patients who had an antibiotic initiated in an outpatient clinic had 2.98 (95% CI: 1.64–5.44, P < .001) times increased odds of inappropriate use.ConclusionsAntibiotics initiated out-of-facility for NH residents constitute a small but not trivial percent of all prescriptions and inappropriate use was high in these settings. Further research is needed to characterize antibiotic prescribing patterns for patients managed in these settings as this likely represents an important, yet under recognized, area of consideration in attempts to improve antibiotic stewardship in NHs.

show abstract

“…10 Additionally, this practice was codified in 2015 by the US Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock Early Management Bundle (SEP-1), a publically reported, "all-or-nothing" ED metric that in part requires broad-spectrum antibiotic administration within 3 hours of sepsis onset. 11 Of course focusing only on the potential benefit for patients with sepsis ignores the societal impact and risk of harm to individual patients when antibiotic therapy is overly broad-spectrum or altogether unnecessary (e.g. conditions that mimic sepsis).…”

mentioning

confidence: 99%

Empiric Antibiotic Prescribing for Suspected Sepsis: A Stewardship Balancing Act

Pulia

Redwood

2020

The American Journal of the Medical Sciences

Self Cite

View full text Add to dashboard Cite

Antimicrobial Stewardship in the Management of Sepsis

Cited by 20 publications

References 118 publications

Examining nursing practices for management of sepsis in low income countries: the case of Uganda

Examining nursing practices for management of sepsis in low income countries: the case of Uganda

Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis

Empiric Antibiotic Prescribing for Suspected Sepsis: A Stewardship Balancing Act

Contact Info

Product

Resources

About