VAAAHS Research Shows Faster Time-to-Treatment for Sepsis Infection Accompanied with Decreased Antibiotic Use, Lower Mortality
The study shows that—contrary to widespread concerns—it is possible to hasten sepsis treatment while simultaneously decreasing overall antibiotic use. Indeed, the majority of the VA hospitals in the study did just that.
A study led by VA Ann Arbor Healthcare System physician Dr. Hallie Prescott addresses growing concerns that the early treatment of sepsis with antimicrobials may lead to increased antimicrobial use.
Sepsis is a life-threatening complication of infection that leads to 50 million hospitalizations and 10 million deaths around the world each year. Doctors use antibiotics to treat the underlying infection triggering sepsis. Faster delivery of antibiotics leads to better survival from sepsis.
However, sepsis can be difficult to diagnose, particularly when a patient first presents for evaluation. Because of this, experts have cautioned that efforts to hasten antibiotic delivery for sepsis may drive up antibiotic use across the board, including in patients who turn out to have non-infectious illnesses.
“Generally, there’s a worry that when you give antibiotics that aren’t needed, patients are exposed unnecessarily to the potential risks of antibiotics such as kidney injury or allergic reaction, so we try to prescribe antibiotics to just those patients who need them,” said Dr. Hallie Prescott, a physician at VA Ann Arbor Healthcare System and internationally-recognized expert on sepsis outcomes. “Also, the more antibiotics we introduce to the population, the more likely we are to breed antibiotic resistance.”
“Some experts worried that our intense focus, in terms of quality improvement efforts, may have unintended consequences. Our efforts to reduce time to treatment for sepsis would spill over into prescribing more antibiotics to other patients,” explained Dr. Prescott.
The study, titled, “Temporal trends in antimicrobial prescribing during hospitalization for potential infection and sepsis,” was published in JAMA Internal Medicine and reported on temporal trends in antibiotic prescribing among over 1.5 million hospitalizations in the nationwide Veterans Affairs and Kaiser Permanente Northern California healthcare systems.
The results of the study showed that both the timing of sepsis treatment and antimicrobial stewardship improved over time. Between 2013 and 2018, the average time to administer antimicrobial among sepsis hospitalizations decreased by 37 minutes, while overall antibiotic use also decreased. Clinical outcomes, such as mortality from sepsis also improved over time.
“This study had a really important and positive finding,” explained Dr. Prescott. “Faster treatment of sepsis and judicious use of antibiotics were often thought to be opposing forces. You’d have to sacrifice one to achieve the other. However, our findings show that it’s possible to do both things. It’s possible to treat sepsis faster and simultaneously make improvements in antimicrobial stewardship.”
Both VA and Kaiser Permanente have robust programs for monitoring antibiotic use, so it’s possible that findings could differ in other hospitals. Nonetheless, this study shows the feasibility of accelerating sepsis care while reducing overall antibiotic use.