Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial

Leeuwen-Nguyen, Hien van; Alam, Nadia; Nanayakkara, Prabath W.B.; Oskam, Erick; Stassen, Patricia M.; Haak, Harm R.; Holleman, F.; Panday, Rishi; Duineveld, Bart A M; Exter, Pieternel van; Ven, Peter M. van de; Bon, Victor; Goselink, J.; Kreek, A. De; Grunsven, Pierre van; Biekart, Marileen; Deddens, G. J.; Weijschede, F.; Rijntjes, N.; Franschman, Gaby; Janssen, Julie M; Frenken, J.W.F.H.; Versluis, Jurjen; Boomars, René; Vries, Gert-Jan de; Boer, Erik den; Gent, A. van; Willeboer, Merel; Buunk, Gerba; Timmers, G.J.; Snijders, Fleur; Posthuma, Nynke; Stoffelen, S.; Claassens, S.; Ammerlaan, H S A; Sankatsing, Sanjay U. C.; Alsma, Jelmer; Zanten, Arthur van; Slobbe, Lany; Melo, Mariane Menezes; Dees, A; Carels, G.; Wabbijn, M.; Leeuwen-Nguyen, T.T.H. van; Assink, J.; Honing, A. van der; Luik, Peter T; Poortvliet, W.; Schouten, W. E. M.; Veenstra, J.; Holkenborg, Joris; Cheung, Tung C.; Bokhorst, J. van; Kors, B. M.; Wattel, G.H. Louis; Roeleveld, T.C.; Toorians, A.; Jellema, Wilbert T.; Govers, A.; Kaasjager, H. A. H.; Dekker, D.; Verhoeven, Martine; Kramer, Mark H. H.; Flietstra, T.; Roest, L.; Peters, Esther; Hekker, T. A. M.; Ang, Wei How Darryl; Wekken, W. van der; Maghami, P. Ghaem; Kanen, B.; Wesselius, Hilde M.; Heesterman, L.; Zwietering, Anne; Stoffers, Judith

doi:10.1016/s2213-2600(17)30469-1

Cited by 229 publications

(193 citation statements)

References 41 publications

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“…Several limitations should be remarked, before generalizing this conclusion, particularly in low and middle-income countries. First, the most common foci of infection in this study were the lungs and the urinary tract (7). The use of antibiotics in the ambulance might be more critical in other clinical conditions such as meningitis or sepsis in immune-compromised subjects.…”

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confidence: 86%

“…Of note, positive cultures were less frequent in the intervention group (25% vs. 37%), suggesting that even one dose of ceftriaxone can negatively affect cultures. Thus, "the authors do not advice antibiotic administration in the ambulance to patients with suspected sepsis" (7). Several limitations should be remarked, before generalizing this conclusion, particularly in low and middle-income countries.…”

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confidence: 98%

“…In this scenario, Alam et al (7) did a randomized openlabel trial, after training nurses from emergency medical service staff, in ten large regional ambulance services serving 34 hospitals in the Netherlands in subjects with inclusion criteria which were suggestive of infection. The intervention group received ceftriaxone a median of 26 min before arriving to the emergency department, whereas median TTA after arriving to emergency department was 70 minutes in the control group.…”

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confidence: 99%

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confidence: 86%

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confidence: 98%

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Best practice for sepsis

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“…The investigators investigated whether patients with sepsis could also benefit from an early prehospital care from specially trained EMS personnel (8). The designed trial tested the hypothesis whether or not increasing the awareness of sepsis with consecutive early administration of antibiotics could lead to an increase in survival of patients compared with those patients receiving usual care.…”

Section: In Their Study Entitled Prehospital Antibiotics In the Ambulmentioning

confidence: 99%

“…As criteria to include patients to the study, they used the following decisive factors: patients needed to be at least 18 years old with a diagnosed or suspected infection, temperature >38 or <36 ℃ and at least one of the following systemic inflammatory response syndromes (pulse >90 beats per minute, respiratory rate >20 per minute) (8).…”

Section: In Their Study Entitled Prehospital Antibiotics In the Ambulmentioning

confidence: 99%

Use of antibiotics in the ambulance for sepsis patients: is earlier really better?

2018

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Antibiotics for Sepsis—Finding the Equilibrium

Klompas

Calandra

Singer

2018

JAMA

141

122

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Sepsis is medicine's last remaining preserve for unrestrained antibiotic prescribing. The Surviving Sepsis Campaign guidelines recommend empirical broadspectrum therapy within one hour of triage for both sepsis and septic shock. 1 This recommendation, and mandates that compel it, encourage clinicians to adopt an approach of "treat first, ask questions later" for patients with any possibility of serious infection. This approach fails to account for the difficulties clinicians face with diagnosing infection, especially when patients initially present to care, and the high rate of overdiagnosis of sepsis, and thus risks promoting excess antibiotic use and causing unintended harm.The recommendation to treat quickly and aggressively may seem sensible because sepsis and septic shock are potentially deadly conditions. Delays in appropriate antimicrobial therapy have been associated with higher mortality rates, and quality improvement initiatives that encouraged earlier prescribing have reported substantial decreases in mortality. Many of the studies supporting these assertions, however, may be biased. Most of these investigations failed to account for VIEWPOINT

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Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial

Cited by 229 publications

References 41 publications

Best practice for sepsis

Best practice for sepsis

Use of antibiotics in the ambulance for sepsis patients: is earlier really better?

Antibiotics for Sepsis—Finding the Equilibrium

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