Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2017 Nov;43(11):1602-1612.
doi: 10.1007/s00134-017-4782-4. Epub 2017 May 2.

Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial

Frank Bloos  1   2 , Hendrik Rüddel  1   2 , Daniel Thomas-Rüddel  1   2 , Daniel Schwarzkopf  1 , Christine Pausch  3 , Stephan Harbarth  4 , Torsten Schreiber  5 , Matthias Gründling  6 , John Marshall  7 , Philipp Simon  8 , Mitchell M Levy  9 , Manfred Weiss  10 , Andreas Weyland  11 , Herwig Gerlach  12 , Tobias Schürholz  13   14 , Christoph Engel  3 , Claudia Matthäus-Krämer  1 , Christian Scheer  6 , Friedhelm Bach  15 , Reimer Riessen  16 , Bernhard Poidinger  1   2 , Karin Dey  17 , Norbert Weiler  18 , Andreas Meier-Hellmann  19 , Helene H Häberle  20 , Gabriele Wöbker  21 , Udo X Kaisers  8   22 , Konrad Reinhart  23   24 ; MEDUSA study group
Affiliations
Randomized Controlled Trial

Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial

Frank Bloos et al. Intensive Care Med. 2017 Nov.

Abstract

Purpose: Guidelines recommend administering antibiotics within 1 h of sepsis recognition but this recommendation remains untested by randomized trials. This trial was set up to investigate whether survival is improved by reducing the time before initiation of antimicrobial therapy by means of a multifaceted intervention in compliance with guideline recommendations.

Methods: The MEDUSA study, a prospective multicenter cluster-randomized trial, was conducted from July 2011 to July 2013 in 40 German hospitals. Hospitals were randomly allocated to receive conventional continuous medical education (CME) measures (control group) or multifaceted interventions including local quality improvement teams, educational outreach, audit, feedback, and reminders. We included 4183 patients with severe sepsis or septic shock in an intention-to-treat analysis comparing the multifaceted intervention (n = 2596) with conventional CME (n = 1587). The primary outcome was 28-day mortality.

Results: The 28-day mortality was 35.1% (883 of 2596 patients) in the intervention group and 26.7% (403 of 1587 patients; p = 0.01) in the control group. The intervention was not a risk factor for mortality, since this difference was present from the beginning of the study and remained unaffected by the intervention. Median time to antimicrobial therapy was 1.5 h (interquartile range 0.1-4.9 h) in the intervention group and 2.0 h (0.4-5.9 h; p = 0.41) in the control group. The risk of death increased by 2% per hour delay of antimicrobial therapy and 1% per hour delay of source control, independent of group assignment.

Conclusions: Delay in antimicrobial therapy and source control was associated with increased mortality but the multifaceted approach was unable to change time to antimicrobial therapy in this setting and did not affect survival.

Keywords: Antimicrobial agents; Critical illness; Quality improvement; Septic shock/drug therapy.

PubMed Disclaimer

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Fam Pract. 2000 Feb;17 Suppl 1:S11-6 - PubMed
    1. Pharm Stat. 2013 Sep-Oct;12(5):268-74 - PubMed
    1. Crit Care Med. 2010 Apr;38(4):1045-53 - PubMed
    1. Acad Emerg Med. 2002 Apr;9(4):330-41 - PubMed
    1. Crit Care Med. 2017 Feb;45(2):241-252 - PubMed

Publication types

Substances