Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department.
Clin Infect Dis. 2017 Jun 12;:
Authors: Viale P, Tedeschi S, Scudeller L, Attard L, Badia L, Bartoletti M, Cascavilla A, Cristini F, Dentale N, Fasulo G, Legnani G, Trapani F, Tumietto F, Verucchi G, Virgili G, Berlingeri A, Ambretti S, De Molo C, Brizi M, Cavazza M, Giannella M
Abstract
Background.: To assess the impact on all-cause 14-day survival of the implementation of an infectious disease (ID) team for the early management of severe sepsis/septic shock (SS/SS) in the Emergency Department (ED).
Methods.: A quasi-experimental pre-post study was carried-out at the general ED of our 1,420-bed teaching hospital. During the pre phase (June 2013-July 2014) all consecutive adult patients with SS/SS were managed according to standard-of-care and data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team by a bedside patient evaluation within 1 hour from ED arrival.
Results.: Overall, 382 patients were included, 195 in the pre and 187 in the post phase. Median age was 82 years (IQR 70-88). Most common infection sources were lung (43%) and urinary tract (17%), in 22% of cases infection source remained unknown. During the post phase the overall compliance with the Surviving Sepsis Campaign (SSC) bundle and the appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P<0.001), and from 30% to 79% (P<0.001), respectively. At multivariate analysis, predictors of 14-day mortality were: qSOFA ≥ 2 [HR 1.68, 1.15-2.45, P=0.007], serum lactate ≥ 2 mmol/L [HR 2.13, 1.39-3.25, P<0.001], and unknown infection source [HR 2.07, 1.42-3.02, P<0.001], while being attended during the post phase was a protective factor [HR 0.64, 0.43-0.94, P=0.026].
Conclusion.: The implementation of an ID team dedicated to the early management of SS/SS in ED improved the adherence to SSC recommendation and patient survival.
PMID: 28605525 [PubMed - as supplied by publisher]