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

Ricard Ferrer, María Luisa Martínez, Gemma Gomà, David Suárez, Luis Álvarez-Rocha, María Victoria de la Torre, Gumersindo González, Rafael Zaragoza, Marcio Borges, Jesús Blanco, Eduardo Palencia Herrejón, Antonio Artigas, María Luisa Martínez, María del Mar Cruz, Sandra Barbadillo, Francisco Fernández, Ma Teresa Rey Rilo, Luis Alvarez Rocha, Belén Jiménez Bartolomé, Juan Diego Jiménez DelgadoDemetrio Carriedo Ule, Ana María Domínguez Berro, Francisco Javier Díaz Domínguez, Juan Machado Casas, Clara Laplaza Santos, Manuel García-Montesinos, Enrique Maraví Poma, Pablo Vidal Cortés, Miguel Martínez Barrio, Ma Jesús López Pueyo, María Jesús López Cambra, Pau Torrabadella, Álvaro Salcedo, Claudio Durán, Iratxe Seijas, Teresa Recio Gómez, Ángel Arenzana, Izaskun Azkarate, Sandra Rodríguez Bolaño, Pablo Olivares García, Jordi Solé Violán, Gerardo Aguilar Aguilar, Ángel Rodríguez Rencinas, Marta Paz Pérez, Elena Pérez Losada, Fernando Martínez Sagasti, José Luis García Allut, Fernando Díez Gutiérrez, Francisco Gandía, Amanda Francisco Amador, Ramón Vegas Pinto, Pilar Martínez Trivez, Nieves García Vázquez, Luis Zapata, Paula Vera, Eduardo Antón, Juan Carlos Yébenes, María de las Olas Cerezo Arias, Francisco García delgado, Javier Fierro Rosón, Josefa Peinado Rodríguez, María Álvarez, Paco Álvarez Lerma, Francisco Valenzuela, Patricia Albert de la Cruz, Rafael Blancas Gómez-Casero, Montserrat Sisón Heredia, Perico Olaechea, Celia Sañudo, José Manuel Gutiérrez Rubio, Roberto Reig Valero, Hasania Abdel-Hadi Álvarez, Leandro Fajardo Feo, Pau Garro, Francisco Navarro Pellejero, Ana Esther Trujillo Alonso, Rosa Catalán, Assumpta Rovira, Nicolás Rico, José Manuel Allegue Gallego, José Córdoba Alonso, Dolores Ocaña, Juan Mora Ordóñez, Manuel Salido Mota, Ma José Tolón Herrera, Paloma Dorado, Arantxa Lander Azcona, Diego Mendoza, Francisca Prieto, Ma Carmen Ramagge Martín, José Ignacio Ayestarán Rota, Enrique Piacentini, Josep Maria Sirvent, Cristina Murcia, Gina Rognoni, José Antonio Gonzalo, Diego Parra Ruiz, Natalia Bretón Díez, José Ignacio Argüelles Antuña, Leonardo Lorente Ramos

Research output: Contribution to journalArticleResearchpeer-review

13 Citations (Scopus)

Abstract

© 2018 The Author(s). 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.
Original languageEnglish
Article number167
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - 22 Jun 2018

Keywords

  • De-escalation
  • Hospital mortality
  • Quality improvement
  • Sepsis
  • Septic shock
  • Timing of antibiotics

Fingerprint Dive into the research topics of 'Improved empirical antibiotic treatment of sepsis after an educational intervention: The ABISS-Edusepsis study'. Together they form a unique fingerprint.

  • Cite this

    Ferrer, R., Martínez, M. L., Gomà, G., Suárez, D., Álvarez-Rocha, L., de la Torre, M. V., González, G., Zaragoza, R., Borges, M., Blanco, J., Herrejón, E. P., Artigas, A., Martínez, M. L., del Mar Cruz, M., Barbadillo, S., Fernández, F., Rilo, M. T. R., Rocha, L. A., Bartolomé, B. J., ... Ramos, L. L. (2018). Improved empirical antibiotic treatment of sepsis after an educational intervention: The ABISS-Edusepsis study. Critical Care, 22(1), [167]. https://doi.org/10.1186/s13054-018-2091-0