Impact of 1-hour and 3-hour sepsis time bundles on patient outcomes and antimicrobial use: A before and after cohort study

Abstract

Background: Sepsis bundles, promulgated by Surviving Sepsis Campaign have not been widely adopted because of variability in sepsis identification strategies, implementation challenges, concerns about excess antimicrobial use, and limited evidence of benefit.; Methods: A 1-hour septic shock and a 3-hour sepsis bundle were implemented using a Breakthrough Series Collaborative in 14 public hospitals in Queensland, Australia. A before (baseline) and after (post-intervention) study evaluated its impact on outcomes and antimicrobial prescription in patients with confirmed bacteremia and sepsis.; Findings: Between 01 July 2017 to 31 March 2020, of 6976 adults presenting to the Emergency Departments and had a blood culture taken, 1802 patients (732 baseline, 1070 post-intervention) met inclusion criteria. Time to antibiotics in 1-hour 73.7% vs 85.1% (OR 1.9 [95%CI 1.1-3.6]) and the 3-hour bundle compliance (48.2% to 63.3%, OR 1.7, [95%CI 1.4 to 2.1]) improved post-intervention, accompanied by a significant reduction in Intensive Care Unit (ICU) admission rates (26.5% vs 17.5% (OR 0.5, [95%CI 0.4 to 0.7]). There were no significant differences in-hospital and 30-day post discharge mortality between the two phases. In a post-hoc analysis of the post-intervention phase, sepsis pathway compliance was associated with lower in-hospital mortality (9.7% vs 14.9%, OR 0.6, 95%CI 0.4 to 0.8). The proportions of appropriate antimicrobial prescription at baseline and post-intervention respectively were 55.4% vs 64.1%, (OR 1.4 [95%CI 0.9 to 2.1]).; Interpretation: Implementing 1-hour and 3-hour sepsis bundles for patients presenting with bacteremia resulted in improved bundle compliance and a reduced need for ICU admission without adversely influencing antimicrobial prescription. (© 2021 The Authors.)eCollection. Cited Medium: Internet. NLM ISO Abbr: Lancet Reg Health West Pac. PubMed Central ID: PMC8654968. Linked References: Crit Care Med. 2006 Nov;34(11):2707-13. (PMID: 16943733); Crit Care. 2014 May 31;18(3):R112. (PMID: 24887215); Lancet Respir Med. 2018 Nov;6(11):821-823. (PMID: 30150012); Crit Care Med. 2007 Apr;35(4):1105-12. (PMID: 17334251); JAMA. 2016 Feb 23;315(8):775-87. (PMID: 26903336); Intensive Care Med. 2017 Mar;43(3):304-377. (PMID: 28101605); Clin Infect Dis. 2018 May 2;66(10):1631-1635. (PMID: 29182749); Crit Care. 2017 Oct 31;21(1):268. (PMID: 29089025); Chest. 2006 Feb;129(2):225-232. (PMID: 16478835); J Biomed Inform. 2009 Apr;42(2):377-81. (PMID: 18929686); Med J Aust. 2016 Feb 1;204(2):73. (PMID: 26821106); Emerg Med J. 2010 Feb;27(2):110-5. (PMID: 20156862); Crit Care Med. 2018 Oct;46(10):1585-1591. (PMID: 30015667); J Antimicrob Chemother. 2015;70(6):1912-8. (PMID: 25724986); Intensive Care Med. 2015 Sep;41(9):1620-8. (PMID: 26109396); N Engl J Med. 2017 Jun 8;376(23):2223-2234. (PMID: 28320242); Crit Care Med. 2006 Apr;34(4):943-9. (PMID: 16484902); JAMA. 2018 Oct 9;320(14):1433-1434. (PMID: 30242350); N Engl J Med. 2017 Jun 8;376(23):2235-2244. (PMID: 28528569); Intensive Care Med. 2018 Jun;44(6):925-928. (PMID: 29675566); Crit Care. 2005;9(6):R764-70. (PMID: 16356225); Crit Care Med. 2017 Sep;45(9):1443-1449. (PMID: 28817480); Ann Intern Med. 2021 Jul;174(7):927-935. (PMID: 33872042); JAMA. 2008 May 21;299(19):2294-303. (PMID: 18492971); Lancet. 2020 Jan 18;395(10219):200-211. (PMID: 31954465); Clin Infect Dis. 2021 Feb 16;72(4):541-552. (PMID: 32374861). Linking ISSN: 26666065. Subset: PubMed not MEDLINE; Date of Electronic Publication: 2021 Nov 02. ; Original Imprints: Publication: [London] : Elsevier Ltd., [2020]- <br />