The following is a summary of “Association of a sepsis initiative on broad spectrum antibiotic use and outcomes in an ED population,” published in the September 2023 issue of Emergency Medicine by Flack, et al.

Sepsis is a critical concern for emergency department (ED) healthcare providers and healthcare payors. However, the stringent measures aimed at enhancing sepsis care may have unintended consequences for patients who do not actually have sepsis.

The study encompassed all patient visits to the ED over one month, both before and after a quality initiative was implemented to increase the early use of antibiotics in septic patients. The study compared the overall usage of broad-spectrum (BS) antibiotics, admission rates, and mortality between these two time periods. Furthermore, a detailed chart review was conducted on patients who received BS antibiotics in both the pre-and post-implementation cohorts. Patients were excluded from the study if they were pregnant, under 18 years of age, had a COVID-19 infection, were in hospice care, left the ED against medical advice, or if antibiotics were administered for prophylactic purposes. For patients who received BS antibiotics, the study aimed to determine mortality rates, the occurrence of subsequent multidrug-resistant (MDR) or Clostridium difficile (C. diff) infections, and the percentage of non-infected patients who were treated with BS antibiotics.

During the pre-and post-implementation periods, there were 7,967 and 7,407 ED visits, respectively. The administration of BS antibiotics increased from 3.9% in the pre-implementation period to 6.2% in the post-implementation period (P ≤ 0.00001). Admission rates were more frequent in the post-implementation period, but overall mortality rates remained unchanged (0.9% in the pre-implementation period and 0.8% in the post-implementation period, P = 0.41). After exclusions, the secondary analyses included 654 patients treated with BS antibiotics. Baseline characteristics were similar between the two cohorts (pre-implementation and post-implementation). There were no significant differences in the rates of C. diff infection or the proportion of non-infected patients who received BS antibiotics. However, there was an increase in the occurrence of MDR infections after receiving BS antibiotics in the post-implementation period, accounting for 0.72% compared to 0.35% of the entire ED cohorts (P = 0.0009).

The study indicated that a quality improvement (QI) initiative for sepsis led to an increase in the number of ED patients receiving BS antibiotics. It resulted in a slight increase in MDR infections post-implementation, with no observed impact on overall mortality in all ED patients or those treated with BS antibiotics. Future research should focus on assessing the broader implications of aggressive sepsis protocols and initiatives on all patients, not just those with sepsis.

Source: sciencedirect.com/science/article/abs/pii/S073567572300308X