1054. Validation of a Current Severe Sepsis Antibiotic Treatment Algorithm: Identifying Areas for Further Refinement
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • ID Week 2013 Sepsis Algorithm Poster.pdf (1.8 MB)
  • Background: The 2012 Surviving Sepsis Campaign guideline has identified the initiation of active antibiotic therapy within 1 hour of severe sepsis and septic shock (SS/SS) as a key goal of therapy.  Empiric antibiotic selection at our institution is guided by a SS/SS treatment algorithm/orderset based on hospital-wide blood culture data and tailored to suspected source and healthcare exposure.  Study objectives were to 1) determine if our existing algorithm/orderset adequately treats SS/SS and 2) provide guidance on best practices in designing a treatment algorithm for SS/SS.

    Methods: This retrospective, single center study evaluated SS/SS patients with positive microbiologic cultures over a 1 year period.  Study endpoints included the percent of patients who received active therapy against causative pathogens within 1 hour.  Antibiotic recommendations were vetted against the organisms isolated within each arm of the algorithm.

    Results: ­ 248 of 664 SS/SS patients had positive cultures.  105 of 248 (42%) patients received any antibiotic and 21% received active therapy against their causative pathogen(s) within 1 hour. Median time to administration of active therapy was 3.2 hours (range = 0 to 305 hours).  Use of the algorithm orderset occurred in only 84/248 (34%) encounters.  Risk factors for inactive therapy within 1 hour included not using the algorithm orderset (p=0.014), allergy to beta-lactams (p=0.016), and polymicrobial or fungal infections (p<0.001).  Adherence to the orderset would have provided active empiric therapy against 84% of pathogens.  Multi-drug resistant gram negatives, vancomycin-resistant enterococci, and fungi were commonly missed by the algorithm.  Algorithm recommendation mismatches with causative pathogens occurred most often with community/nosocomial abdominal and nosocomial skin/skin structure sources.

    Conclusion: Use of the sepsis algorithm orderset improved the likelihood that patients received active therapy within 1 hour.  Hospital antibiograms may not be adequate to develop antibiotic treatment recommendations for SS/SS for some suspected sources. A population specific evaluation is necessary to develop an antibiotic treatment algorithm tailored to the local SS/SS patient population.

    Elizabeth S. Zhu, Pharm.D., BCPS, Pharmacy Services, University of Cailfornia, Davis Medical Center, Sacramento, CA, Cinda Christensen, Pharm.D., BCPS-ID, Pharmacy Services, University of California, Davis Medical Center, Sacramento, CA and Hien H. Nguyen, MD, MAS, Internal Medicine, University of California, Davis Medical Center, Sacramento, CA


    E. S. Zhu, None

    C. Christensen, None

    H. H. Nguyen, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.