Evidence indicates that the use of severe sepsis and septic shock (SS/SS) treatment bundles is associated with lower mortality when compared with no use. However, delivering successful SS/SS bundles can also increase risks for antibiotic overuse and higher rates of C. difficile colitis. For a study published in Open Forum Infectious Disease, Theresa Madaline, MD, and colleagues sought to determine a multidisciplinary approach that would provide patients the benefits of the SS/SS bundle while also providing the opportunity to optimize antimicrobial prescribing and diagnostic workup.
The study team investigated whether a collaboration between emergency medicine and infectious diseases that offered an early infectious disease consultation for patients with SS/SS could improve outcomes. Specifically, they analyzed whether patients who received an infectious disease consultation within 12 hours of arrival showed significant differences in mortality, 30-day hospital readmission, length of stay, and antimicrobial prescribing. Participants had received all components of the 3-hour bundle, in order to evaluate whether the benefits of early identification consultation beyond improving bundle compliance.
The study findings increase the body of evidence that infectious disease consultation, especially early in a patient’s clinical course, are associated with lower mortality, according to Dr. Madaline. Indeed, the in-hospital mortality rates were 24.3% for the early consultation group, compared with 38.0% for the no consultation group. Early ID consultation was protective of in-hospital mortality (adjusted subdistribution hazard ratio (asHR), 0.60) and predictive of discharge alive (asHR 1.58) after adjustment. “We also demonstrated earlier de-escalation of antibiotics with early consultation, which could be a contributing factor for the observed difference in mortality,” adds Dr. Madaline. “Data suggest the collaborative nature of the emergency medicine and infectious diseases service, and the benefits of team-based care, contribute to the lower mortality in the early infectious diseases group.”
Further research is needed to understand the relationship between mortality and antimicrobial de-escalation, says Dr. Madaline. In the meantime, she emphasizes that “it is important to remember that diagnosing and treating SS/SS can be a challenge, and there is ‘no one size fits all’ model. Teamwork and clinical judgement are key.”
Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle