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Clin Infect Dis. 2017 Oct 15;65(8):1253-1259. doi: 10.1093/cid/cix548.

Infectious Diseases Team for the Early Management of Severe Sepsis and Septic Shock in the Emergency Department.

Author information

1
Infectious Diseases Unit, Department of Medical and Surgical Sciences, Hospital S. Orsola-Malpighi, University of Bologna.
2
Clinical Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia.
3
Microbiology, Department of Diagnosis and Prevention, St. Orsola-Malpighi University Hospital, Bologna, Italy.
4
Emergency Department, Hospital S. Orsola-Malpighi, University of Bologna, Italy.

Abstract

Background:

The impact on patient survival of an infectious disease (ID) team dedicated to the early management of severe sepsis/septic shock (SS/SS) in Emergency Department (ED) has yet to be assessed.

Methods:

A quasiexperimental pre-post study was performed at the general ED of our hospital. During the pre phase (June 2013-July 2014), all consecutive adult patients with SS/SS were managed according to the standard of care, data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team performing a bedside patient evaluation within 1 hour of ED arrival.

Results:

Overall, 382 patients were included, 195 in the pre phase and 187 in the post phase. Median age was 82 years (interquartile range, 70-88). The most common infection sources were lung (43%) and urinary tract (17%); in 22% of cases, infection source remained unknown. During the post phase, overall compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P < .001) and from 30% to 79% (P < .001), respectively. Multivariate analysis showed that predictors of all-cause 14-day mortality were quick sepsis-related organ failure assessment ≥2 (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.15-2.45; P = .007), serum lactate ≥2 mmol/L (HR, 2.13; 95% CI, 1.39-3.25; P < .001), and unknown infection source (HR, 2.07; 95% CI, 1.42-3.02; P < .001); being attended during the post phase was a protective factor (HR, 0.64; 95% CI, 0.43-0.94; P = .026).

Conclusion:

Implementation of an ID team for the early management of SS/SS in the ED improved the adherence to SSC recommendations and patient survival.

KEYWORDS:

emergency department; infectious disease consultant; mortality; sepsis; septic shock

PMID:
28605525
DOI:
10.1093/cid/cix548
[Indexed for MEDLINE]

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