Quicker antimicrobial treatment for sepsis doesn't lead to overuse: JAMA
USA: Shortening the time to antibiotics administration for sepsis did not lead to increased antibiotic use and is feasible, according to a study involving more than 1.5 million US hospital patients. The findings of the study, published in JAMA Internal Medicine may ease antimicrobial stewardship concerns about sepsis treatment guidelines.and
The researchers reported that the adjusted median time to first antibiotic administration in sepsis patients fell by 37 minutes from 2013 through 2018. But the days of antibiotic therapy among patients with sepsis also declined, and patient outcomes improved during the same period.
Some experts have cautioned that national and health system emphasis on rapid antimicrobials administration for sepsis may increase the overall use of antimicrobials even among patients without sepsis. This prompted Hallie C. Prescott, Department of Internal Medicine, University of Michigan, Ann Arbor, and colleagues to assess whether temporal changes in antimicrobial timing for sepsis are linked to increasing antimicrobial use, days of therapy, or broadness of antimicrobial coverage among all hospitalized patients at risk for sepsis in an observational cohort study.
The study was conducted on hospitalized patients at 152 hospitals in 2 health care systems from 2013 to 2018, admitted via the emergency department with 2 or more systemic inflammatory response syndrome (SIRS) criteria. Data were analyzed from June 10, 2021, to March 22, 2022.
Antimicrobial outcomes included days of therapy, antimicrobial use, and broadness of antibacterial coverage. Clinical outcomes were 30-day mortality, in-hospital mortality, new multidrug-resistant (MDR) organism culture positivity, and length of hospitalization.
273 255 (17.5%) met objective criteria for sepsis among 1 559 523 patients admitted to the hospital via the emergency department with 2 or more SIRS criteria (1 269 998 male patients [81.4%]; median age, 67 years).
Based on the study, the researchers found the following:
- In multivariable models adjusted for patient characteristics, the adjusted median time to first antimicrobial administration to patients with sepsis decreased by 37 minutes, from 4.7 hours in 2013 to 3.9 hours in 2018, although the slope of decrease varied across hospitals.
- During the same period, antimicrobial use within 48 hours, days of antimicrobial therapy, and receipt of broad-spectrum coverage decreased among the broader cohort of patients with SIRS.
- In-hospital mortality, 30-day mortality, length of hospitalization, new MDR culture positivity, and new MDR blood culture positivity decreased over the study period among both patients with sepsis and those with SIRS.
- When examining hospital-specific trends, decreases in antimicrobial use, days of therapy, and broadness of antibacterial coverage for patients with SIRS did not differ by hospital antimicrobial timing trend for sepsis.
- There was no evidence that accelerating antimicrobial timing for sepsis was associated with increasing antimicrobial use or impaired antimicrobial stewardship.
Findings from a multihospital cohort study showed that the time to the first antimicrobial for sepsis decreased over time, but this trend was not associated with increasing antimicrobial use, days of therapy, or broadness of antimicrobial coverage among the broader population at-risk for sepsis.
This led the authors to conclude, that "shortening the time to antibiotics for sepsis is feasible without leading to indiscriminate antimicrobial use."
Reference:
Prescott HC, Seelye S, Wang XQ, et al. Temporal Trends in Antimicrobial Prescribing During Hospitalization for Potential Infection and Sepsis. JAMA Intern Med. Published online June 27, 2022. doi:10.1001/jamainternmed.2022.2291
