Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department.
Open accessAbstract
Background: The impact on patient survival of an infectious disease (ID) team dedicated to the early management of severe sepsis/septic shock (SS/SS) in Emergency Department (ED) has yet to be assessed. Methods: A quasiexperimental pre-post study was performed at the general ED of our hospital. During the pre phase (June 2013-July 2014), all consecutive adult patients with SS/SS were managed according to the standard of care, data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team performing a bedside patient evaluation within 1 hour of ED arrival. Results: Overall, 382 patients were included, 195 in the pre phase and 187 in the post phase. Median age was 82 years (interquartile range, 70-88). The most common infection sources were lung (43%) and urinary tract (17%); in 22% of cases, infection source remained unknown. During the post phase, overall compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P < .001) and from 30% to 79% (P < .001), respectively. Multivariate analysis showed that predictors of all-cause 14-day mortality were quick sepsis-related organ failure assessment ≥2 (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.15-2.45; P = .007), serum lactate ≥2 mmol/L (HR, 2.13; 95% CI, 1.39-3.25; P < .001), and unknown infection source (HR, 2.07; 95% CI, 1.42-3.02; P < .001); being attended during the post phase was a protective factor (HR, 0.64; 95% CI, 0.43-0.94; P = .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.
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Specialist consultation appears associated with improved patient outcomes for a variety of infectious syndromes.
“Specialist consultation appears to be associated with improved patient outcomes for a variety of infectious syndromes [295–300].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [300]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
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- Authors
- Viale, P., Tedeschi, S., Scudeller, L., Attard, L., Badia, L., Bartoletti, M., Cascavilla, A., Cristini, F., Dentale, N., Fasulo, G., Legnani, G., Trapani, F., Tumietto, F., Verucchi, G., Virgili, G., Berlingeri, A., Ambretti, S., De Molo, C., Brizi, M., Cavazza, M., & Giannella, M.
- Affiliations
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Policlinico San Matteo Fondazione (IT)
- Corresponding author
- Giannella, Maddalena
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-06-12
- Volume
- 65
- Issue
- 8
- Pages
- 1253-1259
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2626432801
- Cited by
- 81
- References
- 40
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 9 · 2023: 11 · 2022: 12 · 2021: 13 · 2020: 15 · 2019: 6 · 2018: 5 · 2017: 1
- FWCI
- 5.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- severe sepsis, septic shock, emergency department, early management, 14-day mortality, lactate, organ failure assessment, infection source, multidisciplinary care
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Analysis of Variance, Communicable Diseases, Emergency Service, Hospital, Female, Humans, Italy, Male, Middle Aged, Prospective Studies, Referral and Consultation, Risk Factors, Shock, Septic, Sepsis, Young Adult
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