Studies have shown that rates of sepsis have steadily increased over the past decade and account for 2% of all hospital admissions. Nearly half of sepsis patients are eventually managed in ICU settings and account for more than 10% of all ICU admissions overall. Today, more than 750,000 patients are seen each year for sepsis and sepsis-related conditions in the United States, accounting for 4% of all inpatient costs.
In response to increasing sepsis trends, “sepsis pathways” have been developed in hospital settings, aimed at targeting clinical, regulatory, and coding issues that are designed to ultimately improve patient outcomes. The Surviving Sepsis Campaign, for example, has enhanced the public and clinical awareness of sepsis. As a result, evidence-based guidelines have been adopted in an effort to improve severe sepsis and septic shock outcomes by facilitating early identification and evidence-based management.
Taking a Bundled Approach
“Sepsis bundles” have emerged in various forms in an effort to simplify the complex processes of care required for assessing and managing septic patients. The ultimate goals of these bundles are to use evidence-based processes, which when implemented, collectively improve outcomes beyond the effect of any single measure. Although outcomes are difficult to quantify, recent data support processes for early sepsis recognition and strategic interventions. After implementing sepsis bundles, several published studies have demonstrated decreases in mortality and hospital and ICU length of stay, with corresponding rates improving as more hospitals comply with sepsis-related bundle practices.
The Role of Blood Cultures
In addition to strategic interventions, the early collection of laboratory blood cultures is also demonstrating value in the identification and management of sepsis. One prospective study evaluated the individual components of the Surviving Sepsis Campaign and their association with survival in patients with severe sepsis/septic shock. This analysis showed that early administration of antimicrobials (120 minutes or less from sepsis identification) and early blood culture obtainment were the only interventions associated with lower mortality.
Despite its potential advantages, the use of blood cultures remains controversial in sepsis care, and questions persist as to when and how many blood cultures are needed. Recognition of the importance of obtaining blood cultures prior to administering antimicrobials remains a critical goal within sepsis guidelines and highlights the value of a timely and accurate diagnosis. To appropriately consider antimicrobial therapy, clinicians often rely on microbiological confirmation and susceptibility testing that results from positive blood cultures. As hospitals strive to implement sepsis programs and customize screening tools, blood culture obtainment should be required to further our ability to accurately diagnose patients in the fight against sepsis.