24 Ago Infectious Diseases Team for the Early Management of Severe Sepsis and Septic Shock in the Emergency Department
Aim: To assess whether the early involvement of an Infectious Diseases (ID) team in the management of adult patients with severe sepsis/septic shock (SS/SS) in the Emergency Department (ED) can reduce 14-day mortality compared to standard-of-care.
Methods: Prospective, quasi-experimental pre–post study. During the pre phase (Jun 2013–Jul 2014), patients were managed according to the standard of care, during the post phase (Aug 2014–Oct 2015), patients were managed in collaboration with a dedicated ID team, which evaluated patient within 1 hour of ED arrival.
Results. Overall, 382 patients were included, 195 in the pre and 187 in the post phase. During the post phase, compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6% to 32% (p<0.001) and from 30% to 79% (p<0.001), respectively. At multivariate Cox regression analysis predictors of 14-day mortality were: qSOFA ≥2 (HR, 1.68; 95% CI, 1.15–2.45; p=0.007), serum lactate ≥2 mmol/L (HR, 2.13; 95% CI, 1.39–3.25; p<0001), and unknown infection source (HR, 2.07; 95% CI, 1.42–3.02; p<0.001); being attended during the post phase was a protective factor (HR, 0.64; 95% CI, 0.43–0.94; p=0.026).
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.