Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial

Abstract

Delay in antimicrobial therapy and source control was associated with increased mortality but the multifaceted approach was unable to change time to antimicrobial therapy in this setting and did not affect survival.

Bacterial sepsis

“…These authors found that with every hour the antibiotic therapy was delayed, mortality increased by 2%. Delayed treatment of the source infection was also associated with an increase in mortality of 1% per hour [106]. Diverse other studies were also able to prove the association of a delayed first application with increased mortality [6,[107][108][109][110][111] and worsening of secondary endpoints (e. g., acute kidney damage; development of acute respiratory distress syndrome, ARDS; increase of the SOFA score; [112][113][114]) among the investigated patient collective.…”

“…On one hand, delaying (>6 h) surgical treatment of the infection and source control increased mortality by 16.2% (42.9 vs. 26.7%, p < 0.001); on the other, an inadequate antibiotic therapy (irrespective of the time point of the first application) was also associated with a significant increase in mortality (30.3 vs. 40.9%, p < 0.001). After completion of the study, Bloos et al [106] evaluated the entire MEDUSA dataset with a total of 4000 patients, investigating, among other things, the effect of the timepoint of the first application on patient mortality. These authors found that with every hour the antibiotic therapy was delayed, mortality increased by 2%.…”

Is it time to implement door-to-needle time for “infection attacks”?

“…The median time to treatment was 1.5 h in the intervention group and this was not significantly better than the control group [7]. It is important to note that the control group did receive educational components of biannual lectures and newsletter updates.…”

“…In a recent article in this journal, Bloos et al report the results of a cluster randomized trial within 40 German ICUs comparing a multi-faceted enhanced educational and feedback program with a control group receiving standard education surrounding antibiotic therapy of sepsis and septic shock for the primary outcome of 28-day mortality [7]. The multi-faceted intervention resulted in neither a significant reduction in mortality nor a reduced time to receipt of antimicrobial therapy.…”

Sepsis hysteria: excess hype and unrealistic expectations

“…Evidence for the benefits of this recommendation is solely from retrospective analyses of databases with inherent residual confounding and biases, and ques tionable plausibility. 11 No prospective study to our knowledge, including a large randomised trial 12 and multicentre quality improvement programmes, 13,14 has shown outcome benefit. Antibiotic use in emergency departments in English hospitals has doubled since 2015 (Howard P, Rx-Info Define, personal commu nication ), coinciding with the intro duction of the Commissioning for Quality and Innovation quality improvement initiative mandating antibiotic pres cription within 1 h of presentation, yet no clear effect on mortality has been shown.…”