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).
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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