Influence of an Institution-Specific Sepsis Protocol on the Adequacy of Empiric Antimicrobial Therapy

Abstract

Objective: A sepsis protocol including institution-specific antibiotic recommendations based on local susceptibility patterns was implemented at our institution. The purpose of this investigation was to determine the impact of these recommendations on the adequacy of initial empiric therapy in patients with severe sepsis admitted to the intensive care unit. Methods: This was a single-center, retrospective, observational study conducted in a medical intensive care unit at a university-affiliated medical center. Charts of patients identified as having sepsis in our sepsis database from November 2004 to September 2006 were retrospectively reviewed. Adequacy of initial therapy was assessed, as were the number of antibiotics used per patient and 28-day mortality. Results: One hundred nine patients met inclusion criteria for the evaluation. Thirty-eight patients were in the pre-protocol group and 71 patients were in the post-protocol group. Adequacy of initial therapy increased from 68% pre protocol to 85% post protocol (P , 0.05). A secondary analysis showed that if antibiotic recommendations had been followed exactly according to protocol, the number of antibiotics per patient would decrease from 2.47 to 2.11 (P 5 0.017) without changing adequacy of initial treatment. Conclusion: Implementation of a sepsis protocol containing institution-specific antibiotic recommendations was associated with an increased percent of patients receiving adequate empiric antibiotic therapy. Strictly adhering to the institution-specific antibiotic recommendations could result in fewer antibiotics used per patient without reducing the adequacy of empiric treatment.

Implementing a Collaborative Sepsis Protocol on the Time to Antibiotics in an Emergency Department of a Saudi Hospital: Quasi Randomized Study

“…Our results also revealed significant improvement in the adequacy of empiric antimicrobial therapy by the use of an institution-specific antibiotic guideline. In a previous study of similar design and similar intervention, using an antimicrobial guide on the severe sepsis order sheet resulted in improved adequacy of antibiotic therapy [ 28 ]. Despite the multidisciplinary education, the guidelines were either not followed or only partially followed in 38% of cases.…”

Show Me the Money: Long-Term Financial Impact of an Antimicrobial Stewardship Program

“…6 These include effects on reducing intensive care unit and hospital length of stay, minimizing antibiotic resistance, and improving adequacy of empiric therapy. 7,8 Throughout its more than 11 years of existence, our stewardship program has been associated with a dramatic reduc- tion in antimicrobial expenditures. This translates into measurable savings well beyond the salary expenses required to support the program.…”