Protocol Can Speed Antibiotics for Sepsis

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TACOMA, WA – Sepsis, one of the leading causes of death in critical-care units, can progress rapidly, making early initiation of antibiotics critical.

A recent study from Madigan Army Medical Center in Tacoma, WA, underscores that a sepsis protocol can improve time to administration of first dose of antibiotics by emphasizing early, goal-directed therapy.1

Recognizing systemic difficulties that delayed therapy, the emergency department and critical-care leadership at Madigan instituted a sepsis protocol to identify patients with sepsis and expedite antibiotic delivery, according to the authors who sought to determine if the sepsis protocol improved the time to first dose of antibiotics.

Researchers performed a retrospective chart review of patients with sepsis comparing the time from antibiotic order placement to the first dose of antibiotic therapy over a three-year period. Patients receiving vancomycin and ciprofloxacin underwent additional subgroup analysis because those antibiotics were made available by protocol for use without infectious-disease consultation.

The average time to first dose of antibiotics for the pre-sepsis protocol group was 160 minutes, and the average time for the sepsis protocol group was 99 minutes, according to the study. That meant a decrease of 65 minutes for 58 patients receiving vancomycin and 41 minutes for the 30 receiving ciprofloxacin.

Sepsis is a major cause of mortality, killing approximately 1,400 people worldwide every day, with mortality rates from severe sepsis on a similar scale to lung, breast and colon cancer, according to the Surviving Sepsis Campaign, which was developed by the European Society of Critical Care Medicine, the International Sepsis Forum and the Society of Critical Care Medicine to improve management, diagnosis, and treatment of the condition.

About 30% of patients with sepsis die within the first month of diagnosis, and 50% die within six months. The number of severe sepsis cases is set to grow at a rate of 1.5% per annum, adding an additional 1 million cases per year in the United States alone by 2020. The increase is mainly due to the growing use of invasive procedures and increasing numbers of elderly and high-risk individuals, such as those with cancer and HIV.

1. Tipler PS, Pamplin J, Mysliwiec V, Anderson D, Mount CA. Use of a protocolized approach to the management of sepsis can improve time to first dose of antibiotics. J Crit Care. 2012 Oct 24. doi:pii: S0883-9441(12)00305-X. 10.1016/j.jcrc.2012.08.021. [Epub ahead of print] PubMed PMID: 23102528.

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