- Poster presentation
- Open Access
Presence of bacterial infection and duration of antibiotic therapy in patients with standardized sepsis detection in the emergency department
Critical Care volume 18, Article number: P29 (2014)
In 2002 the international Surviving Sepsis Campaign was initiated. Following this, Dutch authorities introduced a nationwide safety campaign, encouraging screening for sepsis and advocating early treatment. In 2010, the Albert Schweitzer hospital, a large community hospital, introduced a screening program for sepsis in the emergency department (ED) . The goal of this study was to evaluate the bacterial outcome in patients targeted with this campaign.
All patients 18 years and older visiting the ED were screened using the criteria of systemic inflammatory response syndrome (SIRS). Patients with more than two SIRS criteria and a clinical suspicion for infection were eligible for prompt antibiotic administration, after a short assessment by an ED physician. Patient data were collected prospectively, but a retrospective analysis was conducted using a cohort of patients presenting in the ED in the first 6 months of 2011. The definitions for sepsis severity were derived from the guidelines of the Surviving Sepsis Campaign in 2008 and criteria to define bacterial infection were derived from an article by Limper and colleagues .
A total of 269 patients were included in the study. Review of infectious outcomes showed no evidence of bacterial disease in 79 (29.4%) patients. Of these patients, 70.9% were in the lowest category of sepsis (SIRS and clinical suspicion of infectious disease). Patients in the lowest category were less likely to suffer from bacterial infection than patients (P = 0.046, see Table 1). In the patients without objective bacterial infection, the median duration of antibiotic treatment was 7 days (IQR 4 to 10). Overall mortality was 7.8 %, which is low compared to current literature regarding (severe) sepsis [3, 4], but comparable to literature addressing SIRS and fever in the ED settings [5–8].
Much effort has been put into promoting early antibiotic treatment for (bacterial) sepsis. However, overtreatment has hardly been addressed and no optimal screening strategy has been identified. Evaluation of our screening protocol using SIRS criteria showed that almost 30% of patients did not suffer from bacterial infection but did receive antibiotic treatment for a median duration of 7 days. Future investigations should address the possible negative effects of overtreatment.
Rivers E, Nguyen B, Havstad S, Early goal-Directed Therapy Collaborative Group, et al.: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307
Limper M, Eeftinck Schattenkerk D, de Kruif MD, van Wissen M, Brandjes DP, Duits AJ, van Gorp EC: One year epidemiology of fever at the emergency department. Neth J Med 2011, 69: 124-128.
Angus DC, Linde-Zwirble WT, Lidicker J: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002
Pittet D, Rangel-Fausto MS, Li N: Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Int Care Med 1995, 21: 302-309. 10.1007/BF01705408
Comstedt P, Storgaard M, Lassen AT: The systemic inflammatory response syndrome (SIRS) in acutely hospitalised medical patients: a cohort study. Scand J Trauma Resusc Emerg Med 2009, 17: 67. 10.1186/1757-7241-17-67
Shapiro N, Howell MD, Bates DW: The association of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infection. Ann Emerg Med 2006, 48: 583-590. 10.1016/j.annemergmed.2006.07.007
Heffner AC, Horton JM, Marchick MR, Jones AE: Etiology of illness in patients with severe sepsis admitted to the hospital from the emergency department. Clin Infect Dis 2010, 50: 814-820. 10.1086/650580
Rangel-Fausto MS, Pittet D, Costigan M: The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 1995, 273: 117-123. 10.1001/jama.1995.03520260039030
About this article
Cite this article
Minderhoud, T., Spruyt, C., Lomax, M. et al. Presence of bacterial infection and duration of antibiotic therapy in patients with standardized sepsis detection in the emergency department. Crit Care 18, P29 (2014). https://doi.org/10.1186/cc14032
- Emergency Department
- Bacterial Infection
- Systemic Inflammatory Response Syndrome
- Lower Category
- Survive Sepsis Campaign