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4CPS-175 Sepsis code: improving outcomes for patients with sepsis
  1. ME Martinez Nuñez1,
  2. N Herranz Muñoz1,
  3. JB Cacho Calvo2,
  4. FJ Esteban Fernandez3,
  5. F Ferrere Gonzalez3,
  6. A Gonzalez Torralba2,
  7. D Molina Arana2,
  8. G Perez Caballero3,
  9. AM Rodriguez Benavente3,
  10. T Molina Garcia1
  1. 1Hospital Universitario de Getafe, Pharmacy, Madrid, Spain
  2. 2Hospital Universitario de Getafe, Clinical Microbiology, Madrid, Spain
  3. 3Hospital Universitario de Getafe, Internal Medicine, Madrid, Spain


Background and Importance Sepsis is a common and potentially life-threatening condition triggered by an infection.

Code Sepsis (CS) includes standardised Surviving-Sepsis-Campaign management bundles meant to guide early recognition and prompt goal-directed therapy, in order to improve clinical outcomes.

Multidisciplinary CS-team daily evaluates all patients with ‘CS-alert’ in order to guarantee compliance with sepsis bundles and promoting appropriate antimicrobial-use.

Aim and Objectives To assess the impact of CS implementation on clinical outcomes and antibiotic therapy.

Material and Methods Experimental study from November-2020 to September-2022. All patients with confirmed sepsis/septic shock were included.

Mean outcome: overall and trend of in-hospital mortality rate (MR).

Secondary variables:

  • Median length of hospital-stay (LOS) and Intensive Care Unit stay (ICU-LOS).

  • Severity criteria: ICU-admission (%).

  • Mean length of antibiotic therapy (LAT): overall, antipseudomonal-carbapenems and antibiotics against resistant-gram-positive bacteria (daptomycin, vancomycin and linezolid).

Secondary variables:Variables were analised by trimesters. Median and interquartile range (IQR) were used to describe all the quantitative variables. Lineal-regression was performed for trend analysis.

All statistical analyses were assessed with SPSS®V25.0. Significance level was 0.05.

Results A total of 422 CS alert was activated in 402 patients. Median age=79 years (RIQ 16), 61.1% males.

Admission ward=12.8% surgical, 81.5% medical and 5,7% ICU.

Global MR was 20.6% with a significantly downward trend (slope=-2.2; CI95% -3.4 to -1.0). The overall MR was reduced in 53.8% (38.9% vs 20.9%).

Median LOS was 8days (RIQ 12) and showed a negative trend (slope=-0.4; CI95% -0.7 to 1.02). The median ICU-LOS stay was 6days (RIQ 8.7) with a 9.0% of ICU-admissions, which also decreased during the study (slope=-0.2; CI95% -0.6 to 0.2).

The overall LAT was 9.3days, with trend toward shorter courses (slope=-3.2; CI95% -0.9 to 0.2). Mean duration of antipseudomonal-carbapenems was 4.2days (slope=-2.2; CI95% -0.5 to 0.1), whereas anti-gram-positive was 5.4days (slope=-0.1; CI95% -0.8 to 0.6).

Conclusion and Relevance The CS implementation was associated with a decrease mortality, with an overall reduce by up to 50%. The downward trend in LOS and ICU-admissions suggests that an early recognition of sepsis and optimised-treatment are crucial in preventing complications.

Daily patient surveillance and follow-up by a multidisciplinary team promoting antimicrobial de-escalation/discontinuation was associated with shorter courses of antibiotics without worsening clinical outcomes.

Conflict of Interest No conflict of interest

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