Antibiotic stewardship works both ways, with the goal being to stop unnecessary use but speed therapy to patients in critical need. They do not get much more critical than those with sepsis, who face rapid organ failure if left untreated.

“Antibiotic stewardship programs and sepsis care programs in facilities should be coordinated because prompt use of antibiotics is a critical component of sepsis care,” the Centers for Disease Control and Prevention (CDC) emphasizes in a recently published report.1

A critical step in sepsis treatment is to assess antibiotic therapy 48 to 72 hours after initiation. This review can inform decisions to stop, change, or continue therapy based on the patient’s status and lab culture results.

An online CDC toolkit2 can help healthcare facilities track sepsis and improve antibiotic treatment, says Lauri Hicks, DO, a medical epidemiologist at the CDC. The toolkit can be used in quality-improvement efforts, particularly those to identify the antibiotics used in sepsis, “so hospitals can facilitate both rapid administration and appropriate de-escalation of antibiotics in sepsis to improve patient care,” the CDC explains.

“There is a lot of opportunity to educate about sepsis prevention and that is where CDC is most active right now,” Hicks says.

That includes a “Get Ahead of Sepsis” campaign that urges patients, their families, and their caregivers, to ask this question: “Could this infection be leading to sepsis?”3

“The purpose of that campaign is to make sure patients with early signs and symptoms [of sepsis] are recognized and given the appropriate medical management triage,” Hicks says.

Those at higher risk for sepsis include babies younger than 1 year, adults 65 and older, and those immune-compromised or with chronic conditions, such as diabetes.

“Sepsis happens when an infection you already have - in your skin, lungs, urinary tract, or somewhere else - triggers a chain reaction throughout your body,” the CDC states. “It is life-threatening, and without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.”

There are about 1.7 million cases of sepsis annually in the United States, resulting in about 270,000 deaths, the CDC reports.

“The other piece of this - when we are talking about antibiotic stewardship, a lot of people think it is about not using antibiotics,” Hicks says. “But in the case of sepsis, it is making sure that patients get exactly what they need when they need it.”

It is important that all the relevant stakeholders in a hospital are aware of sepsis, she adds. “That includes the IPs [infection preventionists] as well as the antibiotic stewardship program, the emergency department physicians, and those working in ICUs.”

“Getting sepsis initiatives in place in facilities is something that IPs are involved in,” says Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC, president of the Association for Professionals in Infection Control and Epidemiology. “These tools from the CDC are so helpful because they standardize that practice. It’s up to the IPs then to individualize that to their facilities and help them get implemented.”

According to the CDC, patients suffering sepsis onset may have signs and symptoms that include:

  • confusion or disorientation,
  • shortness of breath,
  • high heart rate,
  • fever, shivering, or feeling very cold,
  • extreme pain or discomfort,
  • clammy or sweaty skin.

REFERENCES

  1. CDC. Antibiotic Use in the United States, 2018 Update: Progress and Opportunities. 2019. Available at: https://bit.ly/2NjuYU5.
  2. CDC. Hospital Toolkit for Adult Sepsis Surveillance. 2018. Available at: https://bit.ly/2lCHd2h.
  3. CDC. Get Ahead of Sepsis – Know the Risks. Spot the Signs. Act Fast. Available at: https://bit.ly/2lCHGS5.