Evaluation of antibiotic escalation in response to nurse-driven inpatient sepsis screen
© The Author(s) 2021..
Objective: To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution.
Design: Retrospective cohort study.
Setting: Two affiliated academic medical centers in Los Angeles, California.
Patients: Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards.
Methods: We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation.
Results: Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91-4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28-3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34-0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22-0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria.
Conclusions: Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:1 |
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| Enthalten in: |
Antimicrobial stewardship & healthcare epidemiology : ASHE - 1(2021), 1 vom: 01., Seite e59 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Furukawa, Daisuke [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Revised 29.09.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1017/ash.2021.232 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM346841011 |
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| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © The Author(s) 2021. | ||
| 520 | |a Objective: To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution | ||
| 520 | |a Design: Retrospective cohort study | ||
| 520 | |a Setting: Two affiliated academic medical centers in Los Angeles, California | ||
| 520 | |a Patients: Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards | ||
| 520 | |a Methods: We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation | ||
| 520 | |a Results: Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91-4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28-3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34-0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22-0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria | ||
| 520 | |a Conclusions: Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Dieringer, Thomas D |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Mitchell D |e verfasserin |4 aut | |
| 700 | 1 | |a Tong, Julia T |e verfasserin |4 aut | |
| 700 | 1 | |a Cader, Isa A |e verfasserin |4 aut | |
| 700 | 1 | |a Wisk, Lauren E |e verfasserin |4 aut | |
| 700 | 1 | |a Han, Maria A |e verfasserin |4 aut | |
| 700 | 1 | |a Gupta, Summer M |e verfasserin |4 aut | |
| 700 | 1 | |a Kerbel, Russell B |e verfasserin |4 aut | |
| 700 | 1 | |a Uslan, Daniel Z |e verfasserin |4 aut | |
| 700 | 1 | |a Graber, Christopher J |e verfasserin |4 aut | |
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