Prognostic Value of Timing of Antibiotic Administration in Patients With Septic Shock Treated With Early Quantitative Resuscitation

Ryoo, Seung Mok; Kim, Won Young; Sohn, Chang Hwan; Seo, Dong Woo; Oh, Bum Jin; Lim, Kyoung Soo; Koh, Jai‐Kyoung

doi:10.1097/maj.0000000000000423

Cited by 52 publications

(46 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study showed that every hour of delay in appropriate antimicrobial administration in the first 6 hours after hypotension is documented led to a decrease in survival by 7.6% . These results have not always been repeatable in other studies investigating the timeliness of antimicrobial administration in septic shock, however similar findings have been documented in studies looking at sepsis without concurrent shock . In view of this data, intravenous administration of broad‐spectrum antimicrobials should be initiated as rapidly as possible in response to the clinical suspicion of infection in the presence of hypotension …”

Section: Early Initiation Of Anti‐microbial Therapymentioning

confidence: 68%

Antibiotic use in critical illness

Stewart¹,

Allen²

2019

J Vet Emergen Crit Care

View full text Add to dashboard Cite

Objective:To provide a review on the current use of antimicrobials with a discussion on the pharmacokinetic and pharmacodynamic profiles of antimicrobials in critically ill patients, the challenges of drug resistance, the use of diagnostic testing to direct therapy, and the selection of the most likely efficacious antimicrobial protocol. Etiology: Patients in the intensive care unit often possess profound pathophysiologic changes that can complicate antimicrobial therapy. Although many antimicrobials have known pharmacodynamic profiles, critical illness can cause wide variations in their pharmacokinetics. The two principal factors affecting pharmacokinetics are volume of distribution and drug clearance. Understanding the interplay between critical illness, drug pharmacokinetics, and antimicrobial characteristics (ie, time-dependent vs concentration-dependent) may improve antimicrobial efficacy and patient outcome. Diagnosis: Utilizing bacterial culture and susceptibility can aid in identifying drug resistant infections, selecting the most appropriate antimicrobials, and hindering the future development of drug resistance. Therapy: Having a basic knowledge of antimicrobial function and how to use diagnostics to direct therapeutic treatment is paramount in managing this patient population. Diagnostic testing is not always available at the time of initiation of antimicrobial therapy, so empiric selections are often necessary. These empiric choices should be made based on the location of the infection and the most likely infecting bacteria.Prognosis: Studies have demonstrated the importance of moving away from a "one dose fits all" approach to antimicrobial therapy. Instead there has been a move toward an individualized approach that takes into consideration the pharmacokinetic and pharmacodynamic variabilities that can occur in critically ill patients.

show abstract

Section: Early Initiation Of Anti‐microbial Therapymentioning

confidence: 68%

Antibiotic use in critical illness

Stewart¹,

Allen²

2019

J Vet Emergen Crit Care

View full text Add to dashboard Cite

show abstract

“…While appropriate antibiotic therapy should be commenced as early as possible and within 60 minutes for severe sepsis and septic shock, 3 there is little evidence demonstrating the benefit of early antibiotic administration in uncomplicated sepsis. 4,5,17 Thus, it may be more judicious for sepsis pathways to focus on early antibiotic delivery (<60 minutes) for cases suspected of severe sepsis and septic shock, while further timely investigation should be undertaken for cases suspected of uncomplicated sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Although early antibiotic therapy is likely to reduce mortality in severe sepsis, 3 recent debate has focused on the importance of antibiotic appropriateness in addition to timing. 1,4,5 The international 'surviving sepsis' campaign focused on improving outcomes in sepsis. 6 In New South Wales, Australia, the Clinical Excellence Commission (CEC) introduced statewide clinical sepsis pathways for emergency departments and subsequently for non-intensive care unit (non-ICU) inpatient wards in 2014, as part of a quality improvement program.…”

Section: Infect Control Hosp Epidemiol 2017;1-7mentioning

confidence: 99%

“…a Prospective Interventional Study John Burston, MBBS, FRACP; 1,2 Suman Adhikari, B Pharm, Grad Dip Clin Pharm; 2,3 Andrew Hayen, BA(Hons), M. Biostat, PhD; 4,5 Heather Doolan, BN, MPH; 6 Melissa L. Kelly, BMed, MPH&TM; 1,2 Kathy Fu, MBBS; 1,2 Tomas O. Jensen, MD, MSc; 1,2 Pamela Konecny, MBBS, MPH, MD(Res) 1,2 objective. To evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways: a Prospective Interventional Study

Burston

Adhikari

Hayen

et al. 2017

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

OBJECTIVE To evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management. DESIGN Interventional, nonrandomized, controlled study. SETTING Tertiary-care referral hospital, Sydney, Australia. PATIENTS Consecutive, adult, non-intensive care unit (non-ICU) inpatients triggering an institutional clinical sepsis pathway from May to August 2015. INTERVENTION All patients reviewed by an ID Fellow within 24 hours of sepsis pathway trigger underwent case review and clinic file documentation of recommendations. Those not reviewed by an ID Fellow were considered controls and received standard sepsis pathway care. The primary outcome was antibiotic appropriateness 48 hours after sepsis trigger. RESULTS In total, 164 patients triggered the sepsis pathway: 6 patients were excluded (previous sepsis trigger); 158 patients were eligible; 106 had ID intervention; and 52 were control cases. Of these 158 patients, 91 (58%) had sepsis, and 15 of these 158 (9.5%) had severe sepsis. Initial antibiotic appropriateness, assessable in 152 of 158 patients, was appropriate in 80 (53%) of these 152 patients and inappropriate in 72 (47%) of these patients. In the intervention arm, 93% of ID Fellow recommendations were followed or partially followed, including 53% of cases in which antibiotics were de-escalated. ID Fellow intervention improved antibiotic appropriateness at 48 hours by 24% (adjusted risk ratio, 1.24; 95% confidence interval, 1.04-1.47; P=.035). The appropriateness agreement among 3 blinded ID staff opinions was 95%. Differences in intervention and control group mortality (13% vs 17%) and median length of stay (13 vs 17.5 days) were not statistically significant. CONCLUSION Sepsis overdiagnosis and delayed antibiotic optimization may reduce sepsis pathway effectiveness. Early ID AMS improved antibiotic management of non-ICU inpatients with suspected sepsis, predominantly by de-escalation. Further studies are needed to evaluate clinical outcomes. Infect Control Hosp Epidemiol 2017;38:1032-1038.

show abstract

“…Delays of this magnitude have been associated with increased risk of death (101). Another study showed that inability to achieve early resuscitation goals (OR: 1.94, 95% CI: 1.0-3.51) was associated with increased 28-day mortality rate (102). Thus, prompt initiation of EGDT is still recommended for septic shock (103)(104)(105)(106)(107)(108), and many efforts have been made to improve early recognition and treatment of septic shock (109).…”

Section: The Importance Of Early Recognition Of Sepsismentioning

confidence: 99%

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

et al. 2017

View full text Add to dashboard Cite

Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.

show abstract

Prognostic Value of Timing of Antibiotic Administration in Patients With Septic Shock Treated With Early Quantitative Resuscitation

Cited by 52 publications

References 24 publications

Antibiotic use in critical illness

Antibiotic use in critical illness

A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways: a Prospective Interventional Study

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

Contact Info

Product

Resources

About