Concerns about overuse of antibiotics in hospitalized patients addressed in multi-hospital analysis including Kaiser Permanente
By Jan Greene
A large, multi-hospital analysis found that early antibiotics in patients with sepsis led to improved health outcomes without leading to unintended consequences for others, such as increased overall antibiotic use or increase in antibiotic resistance.
The studypublished June 27 in JAMA Internal Medicine, is good news for hospital doctors who want to act quickly to respond to sepsis – the body’s overreaction to an infection – which can become fatal within hours, the lead author said. of the study. Vincent Liu, MD, M.Sc.intensive care physician and researcher at Kaiser Permanente Research Division.
“The focus has been on treating sepsis patients with antibiotics as early as possible, as this is the cornerstone of performance enhancement for this devastating disease,” Liu said. “However, what has been poorly understood is the impact of these efforts on other patients who may receive antibiotics for concern of infection.”
Liu and research collaborator Hallie C. Prescott, MD, M.Sc.critical care physician and associate professor at the University of Michigan, initiated the study with funding from the Agency for Health Care Research and Quality.
Their analysis looked at care at 152 Kaiser Permanente and Veterans Affairs hospitals from 2013 to 2018, involving more than 1.5 million patients. They studied patients admitted to hospital from the emergency department who had at least 2 symptoms of systemic inflammatory response syndrome (SIRS), such as increased heart rate and abnormal body temperature. Patients with symptoms of SIRS would be at risk for sepsis, but many may not have it or need antibiotics.
The researchers then compared the 17% of patients admitted with a diagnosis of sepsis with the whole group, to find out the impact of previous use of antibiotics for sepsis on each group.
The study found that for patients with sepsis, the time to initial antibiotic use decreased by 37 minutes over the 6-year study period (4.7 hours to 3.9), indicating that hospitals were implementing previous treatment advice.
At the same time, hospitals were improving care for sepsis patients, they were not indiscriminately expanding antibiotic use with others, the analysis found. In fact, she identified the opposite: overall antibiotic use decreased, as did the average number of days on antibiotic treatment and the use of broad-spectrum antibiotics. Both groups of patients saw reductions in 30-day mortality, length of hospital stay and positive culture for resistant bacteria.
“The pushback was [time-to-treatment for sepsis] shouldn’t be a performance metric because it’s going to cause more harm than good, and I think our data shows it’s probably doing more good than harm,” Prescott said. “We showed that 152 hospitals were able to make improvements in sepsis management and treatment at the same time, contrary to popular belief.”
The study authors said their findings suggest that antibiotics are targeting the patients who would benefit the most.
“This study adds to our national conversation about how to fight sepsis most effectively,” Liu said. “It also confirms that we now need to look for new opportunities to mitigate sepsis by finding high-risk patients before they arrive at hospital, identifying hospitalized patients most likely to benefit from specific treatments, and improving their recovery afterwards. have survived sepsis.
Read University of Michigan Press release