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. 2023 Feb;36(1):82-87.
doi: 10.37201/req/083.2022. Epub 2022 Nov 4.

Time to decision in sepsis

R Ferrer  1 , J González Del Castillo, M Martínez-Martínez, E P Plata-Menchaca, M N Larrosa
Affiliations

Time to decision in sepsis

R Ferrer et al. Rev Esp Quimioter. 2023 Feb.

Abstract
in English, Spanish

Objective: This study aimed to identify the common barriers leading to delayed initial management, microbiological diagnosis, and appropriate empirical antimicrobial treatment in sepsis.

Methods: A cross-sectional study was performed by the application of a population-based survey. Four different surveys were designed, targeting the healthcare personnel located in main hospital areas [emergency department (SEMES); infectious diseases and clinical microbiology-microbiological diagnosis (SEIMC-M); intensive care and infectious diseases, (SEMICYUC-GTEIS); and infectious diseases and clinical microbiology-clinical diagnosis, (SEIMC-C)].

Results: A total of 700 valid surveys were collected from June to November 2019: 380 (54.3%) of SEMES, 127 (18.1%) of SEIMC-M, 97 (13.9%) de SEMICYUC-GTEIS and 96 (13.7%) of SEIMC-C, in 270 hospitals of all levels of care. The qSOFA score was used as a screening tool. The most used biomarker was procalcitonin (n=92, 39.8%). The sepsis code was implemented in 157 of 235 participating centers (66.2%), particularly in tertiary level hospitals. The mean frequency of contaminated blood cultures was 8.9% (8.7). In 85 (78.7%) centers, positive results of blood cultures were available within the first 72 hours and were communicated to the treating physician effectively by phone or e-mail in 76 (81.7%) cases. The main reason for escalating treatment was clinical deterioration, and the reason for de-escalating antimicrobials was significantly different between the specialties. Quality indicators were not frequently monitored among the different participating centers.

Conclusions: There are significant barriers that hinder adequate management processes in sepsis in Spanish hospitals.

Introducción: Este estudio tuvo como objetivo identificar las barreras comunes que conducen al retraso en el manejo inicial, el diagnóstico microbiológico y el tratamiento antimicrobiano empírico adecuado en la sepsis.

Pacientes y métodos: Se realizó un estudio transversal mediante la aplicación de una encuesta de base poblacional. Se diseñaron cuatro encuestas diferentes, dirigidas al personal de salud ubicado en las principales áreas hospitalarias [urgencias (SEMES); enfermedades infecciosas y microbiología clínica-diagnóstico microbiológico (SEIMC-M); cuidados intensivos y enfermedades infecciosas (SEMICYUC-GTEIS); y enfermedades infecciosas y microbiología clínica-diagnóstico clínico, (SEIMC-C)].

Resultados: Se recogieron un total de 700 encuestas válidas de junio a noviembre de 2019: 380 (54,3%) de SEMES, 127 (18,1%) de SEIMC-M, 97 (13,9%) de SEMICYUC-GTEIS y 96 (13,7%) de la SEIMC-C, en 270 hospitales de todos los niveles de atención. El qSOFA se utilizó principalmente como herramienta de detección. El biomarcador más utilizado fue la procalcitonina (n=92, 39,8%). El código sepsis estaba implementado en 157 de 235 centros participantes (66,2%), particularmente en hospitales de tercer nivel. La frecuencia media de hemocultivos contaminados fue del 8,9% (8,7). En 85 (78,7%) de los centros, los resultados de los hemocultivos positivos estuvieron disponibles en las primeras 72 horas y se comunicaron al médico responsable del paciente por teléfono o correo electrónico en 76 casos (81,7%). El motivo principal de la escalada del tratamiento fue el deterioro clínico y el motivo de la desescalada de los antimicrobianos fue significativamente diferente entre las especialidades. Los indicadores de calidad no se monitorizaban con frecuencia en los diferentes centros.

Conclusión: Existen importantes barreras que dificultan los procesos de manejo adecuado de la sepsis en los hospitales españoles.

Keywords: Sepsis Code; Sepsis management; quality indicators.

PubMed Disclaimer

Conflict of interest statement

MNL has participated as a speaker at scientific meetings sponsored by Accelerate Diagnostics and bioMérieux.

Figures

Figure 1
Figure 1
The time to obtain positive blood culture results depends on the availability of a microbiology laboratory. The numbers represent the proportion of hospitals. There were significant differences in time to results according to the availability of microbiology laboratory (p=0.012)
Figure 2
Figure 2
Centers implementing Sepsis Code protocols. Numbers represent the proportion of participating centers. Significant differences are observed in the availability of Sepsis Code among participating centers according to the level of care (p=0.024)
See this image and copyright information in PMC

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