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. 2019 Oct 31;6(10):ofz408.
doi: 10.1093/ofid/ofz408. eCollection 2019 Oct.

Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

Theresa Madaline  1 , Francis Wadskier Montagne  1 , Ruth Eisenberg  2 , Wenzhu Mowrey  2 , Jaskiran Kaur  3 , Maria Malik  3 , Inessa Gendlina  1 , Yi Guo  1 , Deborah White  4 , Liise-Anne Pirofski  1   5 , Uzma Sarwar  1
Affiliations

Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

Theresa Madaline et al. Open Forum Infect Dis. .

Abstract

Objective: Severe sepsis and septic shock (SS/SS) treatment bundles reduce mortality, and early infectious diseases (ID) consultation also improves patient outcomes. We retrospectively examined whether early ID consultation further improves outcomes in Emergency Department (ED) patients with SS/SS who complete the sepsis bundle.

Method: We included 248 adult ED patients with SS/SS who completed the 3-hour bundle. Patients with ID consultation within 12 hours of ED triage (n = 111; early ID) were compared with patients who received standard care (n = 137) for in-hospital mortality, 30-day readmission, length of hospital stay (LOS), and antibiotic management. A competing risk survival analysis model compared risks of in-hospital mortality and discharge alive between groups.

Results: In-hospital mortality was lower in the early ID group unadjusted (24.3% vs 38.0%, P = .02) and adjusted for covariates (odds ratio, 0.47; 95% confidence interval (CI), 0.25-0.89; P = .02). There was no significant difference in 30-day readmission (22.6% vs 23.5%, P = .89) or median LOS (10.2 vs 12.1 days, P = .15) among patients who survived. A trend toward shorter time to antibiotic de-escalation in the early ID group (log-rank test P = .07) was observed. Early ID consultation was protective of in-hospital mortality (adjusted subdistribution hazard ratio (asHR), 0.60; 95% CI 0.36-1.00, P = .0497) and predictive of discharge alive (asHR 1.58, 95% CI, 1.11-2.23; P-value .01) after adjustment.

Conclusions: Among patients receiving the SS/SS bundle, early ID consultation was associated with a 40% risk reduction for in-hospital mortality. The impact of team-based care and de-escalation on SS/SS outcomes warrants further study.

Keywords: antimicrobial stewardship; bundle; infectious diseases consultation; mortality; sepsis.

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Figures

Figure 1.
Figure 1.
Unadjusted Cumulative Incidence Curves for In-hospital Mortality and Discharge Alive.
Figure 2.
Figure 2.
Kaplan-Meier Plot for Time to Antibiotic De-escalation.
See this image and copyright information in PMC

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