4CPS-175 Sepsis code: improving outcomes for patients with sepsis

• Published in: European journal of hospital pharmacy. Science and practice 2023-03, Vol.30 (Suppl 1), p.A80-A80
• Main Authors: Martinez Nuñez, ME, Herranz Muñoz, N, Cacho Calvo, JB, Esteban Fernandez, FJ, Ferrere Gonzalez, F, Gonzalez Torralba, A, Molina Arana, D, Perez Caballero, G, Rodriguez Benavente, AM, Molina Garcia, T
• Format: Article
• Language: English
• Subjects: Antibiotics; Clinical outcomes; Conflicts of interest; Gram-positive bacteria; Mortality; Section 4: Clinical pharmacy services; Sepsis
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2023-eahp.168

Background and ImportanceSepsis 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 ObjectivesTo assess the impact of CS implementation on clinical outcomes and antibiotic therapy.Material and MethodsExperimental 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).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.ResultsA 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 RelevanceThe 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 p