Impact of Prehospital Antibiotic Therapy on Septic Shock Mortality

Jouffroy, Romain; Gilbert, Basile; Tourtier, Jean Pierre; Bloch-Laine, Emmanuel; Ecollan, Patrick; Bounes, Vincent; Boularan, Josiane; Léguillier, Teddy; Gueye-Ngalgou, Papa; Vivien, Benoît

doi:10.1080/10903127.2020.1763532

Cited by 20 publications

(32 citation statements)

References 40 publications

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“…Our pilot investigation demonstrated that implementing a prehospital protocol for initiation of prehospital antibiotics was feasible and safe, with high paramedic adherence to the protocol. Additional multicenter research is warranted; however, our safety/feasibility findings were consistent with results from the other U.S.-based investigations and multiple European studies, [4][5][6][7][8] Further research is needed to confirm that prehospital antibiotic administration translates to better patient outcomes.…”

supporting

confidence: 82%

“…3 A natural extension of current initiatives to reduce time to antibiotic administration in patients who exhibit sepsis with hypotension or septic shock is to consider implementing prehospital administration of antibiotics.Research regarding the feasibility of this practice and its effectiveness has primarily been performed in Europe. [4][5][6] Few American systems have begun examining similar prehospital antibiotic administration protocols. 7,8 These early studies have demonstrated evidence of improved patient outcomes including shorter intensive care unit (ICU) lengths of stay.…”

mentioning

confidence: 99%

“…Research regarding the feasibility of this practice and its effectiveness has primarily been performed in Europe. [4][5][6] Few American systems have begun examining similar prehospital antibiotic administration protocols. 7,8 These early studies have demonstrated evidence of improved patient outcomes including shorter intensive care unit (ICU) lengths of stay.…”

mentioning

confidence: 99%

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A pilot study of prehospital antibiotics for severe sepsis

Cunningham¹,

Sanseverino

Reznek

et al. 2021

Academic Emergency Medicine

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Severe forms of sepsis are major contributors to morbidity and mortality worldwide, with mortality rates as high as 25%-60%. 1 Sepsis with hypotension and septic shock, which we define as sepsis with a systolic blood pressure ≤ 90 mm Hg that is refractory to an initial fluid bolus, 2 are important subsets of sepsis and are medical emergencies for which timeliness of care is crucial. The literature demonstrates that early administration of antibiotics provides a significant mortality benefit in both conditions. 1 Emergency medical services (EMS) personnel treat the majority of sepsis with hypotension and septic shock cases. 2 Consequently, oversight entities, including the Centers for Medicare & Medicaid Services, are recognizing that EMS providers are an important link in ensuring timely care for patients with sepsis. 3 A natural extension of current initiatives to reduce time to antibiotic administration in patients who exhibit sepsis with hypotension or septic shock is to consider implementing prehospital administration of antibiotics.Research regarding the feasibility of this practice and its effectiveness has primarily been performed in Europe. [4][5][6] Few American systems have begun examining similar prehospital antibiotic administration protocols. 7,8 These early studies have demonstrated evidence of improved patient outcomes including shorter intensive care unit (ICU) lengths of stay. 7,8 The primary aim of our investigation was to describe the safety and feasibility of a protocol for prehospital recognition of sepsis with hypotension and septic shock, drawing of blood cultures, and administration of intravenous (IV) antibiotics in an urban EMS service, thereby adding to the limited U.S. literature available on this subject and supporting the development of a large-scale randomized control trial (RCT). Primary feasibility measures included the frequency of allergic reactions, culture contamination, and paramedic adherence to the protocol in the prehospital environment. Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) were used to report the findings of this preliminary result. 9This pilot study was conducted at a large urban academic medical center under a state-granted special project waiver for the protocol implementation. This two-armed project consisted of a retrospective chart review for the historical cohort and a prospective observational study for the interventional arm.

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supporting

confidence: 82%

mentioning

confidence: 99%

mentioning

confidence: 99%

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A pilot study of prehospital antibiotics for severe sepsis

Cunningham¹,

Sanseverino

Reznek

et al. 2021

Academic Emergency Medicine

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“…We did sensitivity analysis with a leave one out the test. We removed the (Jouffroy et al 12 ) study, so the heterogeneity was solved ( p = 0.86). After postsensitivity analysis, the pooled MD for patients who took prehospital antibiotics was 0.67 (95% CI: 0.33–1.01, p = 0.0001) compared to those who did not take prehospital antibiotics.…”

Section: Resultsmentioning

confidence: 99%

Prehospital administration of broad‐spectrum antibiotics for sepsis patients: A systematic review and meta‐analysis

Varney

Motawea

Kandil

et al. 2022

Health Science Reports

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Background and Aims Some studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta‐analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients. Methods We formulated a search strategy and used it on search databases PubMed, Scopus, Web of Science, and Embase. We then screened the records for eligibility and included controlled studies, either clinical trials or cohort studies reporting prehospital antibiotic administration for sepsis patients. We excluded duplicates, books, conferences' abstracts, case reports, editorials, letters, author responses, not English studies, and studies with nonavailable full text. Animal and lab studies were also excluded. Results The total number of studies identified is 1811, 19 were eligible for systematic review and 4 for meta‐analysis (three cohort and one clinical trial). The total number of sepsis patients in the four included studies in the 28 days mortality outcome was 3523 (1779 took prehospital antibiotics and 1744 did not take prehospital antibiotics). Of 1779 who took the antibiotics, 190 died, and of 1744 who did not take antibiotics, 292 died (95% confidence interval 0.68–0.97, p = 0.02). Conclusion This meta‐analysis reveals that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. However, more clinical trials and multicenter prospective studies with high sample sizes are needed to get strong evidence supporting our findings.

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“…As previously reported [ 29 ], in France, a public health control organisation, the SAMU (Urgent Medical Aid Service) provides the medical response to prehospital emergency medical situations. The SAMU is a dispatch centre where a team of assistants and physicians answer calls and triage the patients’ complaints [ 30 ].…”

Section: Methodsmentioning

confidence: 99%

Prehospital norepinephrine administration reduces 30-day mortality among septic shock patients

et al. 2022

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Background Despite differences in time of sepsis recognition, recent studies support that early initiation of norepinephrine in patients with septic shock (SS) improves outcome without an increase in adverse effects. This study aims to investigate the relationship between 30-day mortality in patients with SS and prehospital norepinephrine infusion in order to reach a mean blood pressure (MAP) > 65 mmHg at the end of the prehospital stage. Methods From April 06th, 2016 to December 31th, 2020, patients with SS requiring prehospital Mobile Intensive Care Unit intervention (MICU) were retrospectively analysed. To consider cofounders, the propensity score method was used to assess the relationship between prehospital norepinephrine administration in order to reach a MAP > 65 mmHg at the end of the prehospital stage and 30-day mortality. Results Four hundred and seventy-eight patients were retrospectively analysed, among which 309 patients (65%) were male. The mean age was 69 ± 15 years. Pulmonary, digestive, and urinary infections were suspected among 44%, 24% and 17% patients, respectively. One third of patients (n = 143) received prehospital norepinephrine administration with a median dose of 1.0 [0.5–2.0] mg h−1, among which 84 (69%) were alive and 38 (31%) were deceased on day 30 after hospital-admission. 30-day overall mortality was 30%. Cox regression analysis after the propensity score showed a significant association between prehospital norepinephrine administration and 30-day mortality, with an adjusted hazard ratio of 0.42 [0.25–0.70], p < 10–3. Multivariate logistic regression of IPTW retrieved a significant decrease of 30-day mortality among the prehospital norepinephrine group: ORa = 0.75 [0.70–0.79], p < 10–3. Conclusion In this study, we report that prehospital norepinephrine infusion in order to reach a MAP > 65 mmHg at the end of the prehospital stage is associated with a decrease in 30-day mortality in patients with SS cared for by a MICU in the prehospital setting. Further prospective studies are needed to confirm that very early norepinephrine infusion decreases septic shock mortality.

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Impact of Prehospital Antibiotic Therapy on Septic Shock Mortality

Cited by 20 publications

References 40 publications

A pilot study of prehospital antibiotics for severe sepsis

A pilot study of prehospital antibiotics for severe sepsis

Prehospital administration of broad‐spectrum antibiotics for sepsis patients: A systematic review and meta‐analysis

Prehospital norepinephrine administration reduces 30-day mortality among septic shock patients

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