The Surviving Sepsis Campaign (SSC) recommends routine screening for severe sepsis and a bundled treatment approach that includes early administration of broad-spectrum antibiotics (BSAs). Hospital-onset Clostridium difficile infection (CDI) is an increasing healthcare problem and BSAs are a major risk factor. The effects of sepsis screening programs and sepsis treatment bundles on BSA use and HO-CDI rates are unknown.
This was a retrospective chart review conducted at The Mount Sinai Hospital (MSH) in New York, NY. In 2012, MSH launched an initiative called “STOP Sepsis” (SS) based on SSC guidelines, which has resulted in a 40% decrease in sepsis related mortality. We extracted administration data of commonly used BSAs, including those featured in the SS treatment bundle (cefepime (CFP) and imipenem (IMI)), ordered for adult patients on medicine and oncology wards before, during, and after SS implementation. BSA use was expressed as days of therapy (DOT) per 1,000 patient-days. Rates of HO-CDI (cases per 10,000 patient-days) affecting the same patient population were also collected. Data were plotted over time and segmented regression based hypothesis tests were performed.
Although overall BSA use changed little pre- and post-SS implementation (-0.9%), there was an increase in the trend of BSA administration in the year during SS implementation (+5.5 per month, P<0.05), which subsequently declined post-SS implementation (-7.9 per month, P<0.05). The increase was driven primarily by CFP and IMI use (+3.7 per month, P<0.05). HO-CDI rates mirrored BSA use; the implementation period saw an increase in trend (+1.4 per month, P<0.05). This reversed a declining trend (-1.5 per month, P<0.05) prior to SS implementation. Overall, HO-CDI rates increased by 23.3% comparing pre- and post-SS implementation.
These preliminary data show that implementation of a sepsis screening protocol and a bundled care treatment initiative as recommended by international guidelines resulted in an increased trend of BSA use on medicine and oncology wards while coinciding with increased HO-CDI rates. These findings highlight the importance of understanding the benefits and risks of adopting sepsis initiatives and monitoring for unintended consequences.
P. Saunders-Hao, None
V. Adams, None
F. Wallach, None
C. Powell, None
A. Glasser, None
M. Mazumdar, None
G. Patel, None
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