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. 2018 Jun 22;22(1):167.
doi: 10.1186/s13054-018-2091-0.

Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study

Ricard Ferrer  1   2 , María Luisa Martínez  3 , Gemma Gomà  4 , David Suárez  5 , Luis Álvarez-Rocha  6 , María Victoria de la Torre  7 , Gumersindo González  8 , Rafael Zaragoza  9 , Marcio Borges  10 , Jesús Blanco  11   12 , Eduardo Palencia Herrejón  13 , Antonio Artigas  11   3   4 ; ABISS-Edusepsis Study group
Collaborators, Affiliations

Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study

Ricard Ferrer et al. Crit Care. .

Abstract

Background: Early appropriate antibiotic treatment is essential in sepsis. We aimed to evaluate the impact of a multifaceted educational intervention to improve antibiotic treatment. We hypothesized that the intervention would hasten and improve the appropriateness of empirical antibiotic administration, favor de-escalation, and decrease mortality.

Methods: We prospectively studied all consecutive patients with sepsis/septic shock admitted to 72 intensive care units (ICUs) throughout Spain in two 4-month periods (before and immediately after the 3-month intervention). We compared process-of-care variables (resuscitation bundle and time-to-initiation, appropriateness, and de-escalation of empirical antibiotic treatment) and outcome variables between the two cohorts. The primary outcome was hospital mortality. We analyzed the intervention's long-term impact in a subset of 50 ICUs.

Results: We included 2628 patients (age 64.1 ± 15.2 years; men 64.0%; Acute Physiology and Chronic Health Evaluation (APACHE) II, 22.0 ± 8.1): 1352 in the preintervention cohort and 1276 in the postintervention cohort. In the postintervention cohort, the mean (SD) time from sepsis onset to empirical antibiotic therapy was lower (2.0 (2.7) vs. 2.5 (3.6) h; p = 0.002), the proportion of inappropriate empirical treatments was lower (6.5% vs. 8.9%; p = 0.024), and the proportion of patients in whom antibiotic treatment was de-escalated was higher (20.1% vs. 16.3%; p = 0.004); the expected reduction in mortality did not reach statistical significance (29.4% in the postintervention cohort vs. 30.5% in the preintervention cohort; p = 0.544). Gains observed after the intervention were maintained in the long-term follow-up period.

Conclusions: Despite advances in sepsis treatment, educational interventions can still improve the delivery of care; further improvements might also improve outcomes.

Keywords: De-escalation; Hospital mortality; Quality improvement; Sepsis; Septic shock; Timing of antibiotics.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by our institutional review board (reference 2,011,521) and the ethics committees at each participating center approved the study protocol and waived the need for informed consent because the intervention was a quality improvement program and patients’ anonymity was guaranteed.

Consent for publication

Not applicable.

Competing interests

AA received funding for himself from Grifols, Lilly Foundation, and Fisher & Paykel. Other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Mean time to first antibiotic after sepsis onset before and after the educational intervention, excluding patients with previous antibiotic treatment (n = 858)
Fig. 2
Fig. 2
Compliance with process-of-care measures in the preintervention vs. postintervention cohort. a The proportion of adherence to the resuscitation bundle in the preintervention vs. postintervention cohort. b Evaluation of treatment at 72 h. c Change of antibiotic at 72 h. NS, not statistically significant; *p < 0.05; ***p < 0.005
See this image and copyright information in PMC

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