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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 125 Research Studies DisplayedScott Scott, Kempe A, Bajaj L
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Researchers sought to identify barriers and facilitators to pediatric sepsis care in general emergency departments (EDs), including care processes, the role of guidelines, and incentivized metrics. They interviewed medical directors, nurse managers, and quality coordinators. They found that leaders in general EDs were motivated to provide high-quality pediatric sepsis care but disagreed on whether reportable metrics would drive improvements. Leaders universally sought direct support from their nearest children's hospitals and actionable guidelines.
AHRQ-funded; HS025696.
Citation: Scott Scott, Kempe A, Bajaj L .
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Ann Emerg Med 2022 Oct;80(4):347-57. doi: 10.1016/j.annemergmed.2022.05.030..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Guidelines, Evidence-Based Practice
Mazi PB, Olsen MA, Stwalley D
Attributable mortality of Candida bloodstream infections in the modern era: a propensity score analysis.
The purpose of this retrospective cohort study was to quantify the mortality attributed to Candida bloodstream infections (BSI). The researchers identified 626 adult patients with Candida BSI that were frequency-matched with 6269 control patients with similar candida BSI risk-factors. The study found that the 90-day crude mortality rate was 42.4% for Candida BSI cases and 17.1% for frequency matched controls. After propensity score-matching, the attributable risk difference for 90-day mortality was 28.4% with hazard ratio (HR) of 2.12. In the stratified analysis, the 90-day mortality risk was highest in patients in the lowest risk quintile to develop Candida BSI. Patients in this lowest risk quintile accounted for 61% of the untreated patients with Candida BSI. Sixty-nine percent of untreated patients died versus 35% of treated patients.
AHRQ-funded; HS019455.
Citation: Mazi PB, Olsen MA, Stwalley D .
Attributable mortality of Candida bloodstream infections in the modern era: a propensity score analysis.
Clin Infect Dis 2022 Sep 29;75(6):1031-36. doi: 10.1093/cid/ciac004..
Keywords: Infectious Diseases, Mortality, Sepsis
Dutta S, McEvoy DS, Rubins DM
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
This paper discusses the outcomes of using a clinical decision support (CDS) tool that was implemented in emergency departments (EDs) for sepsis patients to remind healthcare staff to take blood cultures before administration of intravenous (IV) antibiotics. The study compared timely blood culture collection outcomes prior to IV antibiotics for 54,538 adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. The baseline phase found that 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. The CDS improved blood culture collection rates without increasing overutilization.
AHRQ-funded; HS02717.
Citation: Dutta S, McEvoy DS, Rubins DM .
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
J Am Med Inform Assoc 2022 Sep 12;29(10):1705-14. doi: 10.1093/jamia/ocac115..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Antibiotics, Emergency Department, Medication, Sepsis
Prescott HC, Seelye S, Wang XQ
Temporal trends in antimicrobial prescribing during hospitalization for potential infection and sepsis.
This study examined whether the push to administer antimicrobials to prevent sepsis has increased antimicrobial use in general. This observational cohort study of hospitalized patients at 152 hospitals in 2 health care systems during 2013 to 2018 looked at almost 1.6 million patients (81% male), admitted via the emergency department with 2 or more systemic inflammatory response syndrome (SIRS) criteria. From 2013 to 2018 first antimicrobial administration to patients with sepsis decreased by 37 minutes. At the same time, antimicrobial use within 48 hours, days of antimicrobial therapy, and receipt of broad-spectrum coverage decreased among the broader cohort of patients with systemic inflammatory response syndrome (SIRS). This may have caused a decrease in in-hospital mortality, 30-day mortality, length of hospitalization, new MDR culture positivity, and new MDR blood culture positivity over the study period among both patients with sepsis and those with SIRS. For the overall hospital population there was no evidence that increasing antimicrobial timing for sepsis was associated with increasing antimicrobial use or impaired antimicrobial stewardship.
AHRQ-funded; HS026725.
Citation: Prescott HC, Seelye S, Wang XQ .
Temporal trends in antimicrobial prescribing during hospitalization for potential infection and sepsis.
JAMA Intern Med 2022 Aug;182(8):805-13. doi: 10.1001/jamainternmed.2022.2291..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Sepsis, Inpatient Care, Hospitals
Mohr NM, Schuette AR, Ullrich F
An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.
The purpose of this study will be to assess the impact of provider-focused video telehealth in rural hospital emergency departments (ED) on costs and long-term outcomes for patients with sepsis. Using Medicare administrative claims, the researchers will compare telehealth-subscribing hospitals and control hospitals to assess the differences in total health care expenditures, category-specific costs, length of stay, readmissions, and mortality. The researchers intend for the study results to demonstrate the association between telehealth utilization and sepsis care total expenditures.
AHRQ-funded; HS025753.
Citation: Mohr NM, Schuette AR, Ullrich F .
An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.
J Comp Eff Res 2022 Jul;11(10):703-16. doi: 10.2217/cer-2022-0019..
Keywords: Telehealth, Health Information Technology (HIT), Sepsis, Rural Health, Healthcare Costs
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Balamuth F, Scott HF, Weiss SL
Validation of the pediatric Sequential Organ Failure Assessment score and evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the pediatric emergency department.
This study analyzed whether a measure used to quantity organ dysfunction, the Sequential Organ Failure Assessment (SOFA) in adults can also be used for critically ill children in an emergency department (ED) population. This retrospective cohort study took place in 9 US children’s hospitals included in the Pediatric Emergency Care Applied Research Network (PECARN registry from January 2012 to January 31, 2020. A score of 2 or more can indicate an infection. Almost 4 million ED visits were included, with 3.2% having a pSOFA score of 2 or more. The pSOFA score showed poor sensitivity as a screening tool for hospital mortality but children with a pSOfA score of 2 or less were at very low risk of death, with high specificity and negative predictive value.
AHRQ-funded; HS020270.
Citation: Balamuth F, Scott HF, Weiss SL .
Validation of the pediatric Sequential Organ Failure Assessment score and evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the pediatric emergency department.
JAMA Pediatr 2022 Jul;176(7):672-78. doi: 10.1001/jamapediatrics.2022.1301..
Keywords: Children/Adolescents, Sepsis, Emergency Department
Drewry AM, Mohr NM, Ablordeppey EA
Therapeutic hyperthermia is associated with improved survival in afebrile critically ill patients with sepsis: a pilot randomized trial.
This study’s objective was to test the hypothesis that forced-air warming of critically ill afebrile sepsis patients improves immune function compared to standard temperature management. Patients were considered eligible patients if they were mechanically ventilated septic adults with: 1) a diagnosis of sepsis within 48 hours of enrollment; 2) anticipated need for mechanical ventilation of greater than 48 hours; and 3) a maximum temperature less than 38.3°C within the 24 hours prior to enrollment. Intervention treatment was external warming using a forced-air warming blanket for 48 hours, with a goal temperature 1.5°C above the lowest temperature documented in the previous 24 hours. The authors enrolled 56 patients in this randomized, controlled trial. Participants allocated to external warming had lower 28-day mortality (18% vs 43%) and more 28-day hospital-free days. No differences were observed between the groups in HLA-DR expression or IFN-γ production.
AHRQ-funded; HS025753.
Citation: Drewry AM, Mohr NM, Ablordeppey EA .
Therapeutic hyperthermia is associated with improved survival in afebrile critically ill patients with sepsis: a pilot randomized trial.
Crit Care Med 2022 Jun;50(6):924-34. doi: 10.1097/ccm.0000000000005470..
Keywords: COVID-19, Sepsis, Treatments, Comparative Effectiveness, Evidence-Based Practice, Outcomes
Hannum SM, Oladapo-Shittu O, Salinas AB
A task analysis of central line-associated bloodstream infection (CLABSI) surveillance in home infusion therapy.
This study’s objective was to describe barriers to, facilitators for, and suggested strategies for successful home infusion central line associated bloodstream infection (CLABSI) surveillance. The authors conducted semi-structured interviews with team members involved in CLABSI surveillance at 5 large home infusion agencies to explore work systems used by members for home infusion. They analyzed 21 transcribed interviews qualitatively for themes. Eight steps for performing CLABSI surveillance were revealed. Major surveillance barriers identified included the need for training of the surveillance staff, lack of a standardized definition, inadequate information technology support, struggles communicating with hospitals, inadequate time, and insufficient clinician engagement and leadership support.
AHRQ-funded; HS027819.
Citation: Hannum SM, Oladapo-Shittu O, Salinas AB .
A task analysis of central line-associated bloodstream infection (CLABSI) surveillance in home infusion therapy.
Am J Infect Control 2022 May;50(5):555-62. doi: 10.1016/j.ajic.2022.01.008..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Patient Safety, Sepsis
Cimiotti JP, Becker ER, Li Y
Association of registered nurse staffing with mortality risk of Medicare beneficiaries hospitalized with sepsis.
The purpose of this cross-sectional study was to determine if registered nurse workload was related with mortality in Medicare beneficiaries admitted to an acute care hospital with sepsis. The researchers evaluated the records of Medicare beneficiaries ages 65 to 99 years with a primary diagnosis of sepsis that was present on admission to 1 of 1958 nonfederal, general acute care hospitals that had data on CMS SEP-1 scores and registered nurse workload. Researchers utilized 2018 data from the American Hospital Association Annual Survey, CMS Hospital Compare, and Medicare claims. The patient outcome of interest was mortality within 60 days of admission. The study found that 702,140 Medicare beneficiaries with a mean age of 78.2 years, 51% of whom were women, had a diagnosis of sepsis. In a multivariable regression model, each additional registered nurse hour per patient day (HPPD) was associated with a 3% decrease in the odds of 60-day mortality. The researchers concluded that hospitals which provide more registered nurse hours of care could possibly decrease the likelihood of mortality in Medicare beneficiaries with sepsis.
AHRQ-funded; HS026232.
Citation: Cimiotti JP, Becker ER, Li Y .
Association of registered nurse staffing with mortality risk of Medicare beneficiaries hospitalized with sepsis.
JAMA Health Forum 2022 May;3(5):e221173. doi: 10.1001/jamahealthforum.2022.1173..
Keywords: Sepsis, Mortality, Provider: Nurse, Nursing, Workforce
Dierkes AM, Aiken LH, Sloane DM
Hospital nurse staffing and sepsis protocol compliance and outcomes among patients with sepsis in the USA: a multistate cross-sectional analysis.
The timely and effective administration of sepsis treatment may improve sepsis outcomes, and those improvements may provide evidence of the need for mandated reporting of adherence to sepsis care protocol. The purpose of the study was to better understand the association between patient-to-nurse staffing ratios, sepsis protocol compliance, and patient outcomes. The researchers conducted a cross-sectional study utilizing linked data from 537 hospitals from across California, Florida, Illinois, Pennsylvania, New Jersey, and New York (representing 252,699 Medicare inpatients with sepsis present on admission), nurse and hospital surveys, and Centers for Medicare and Medicaid Services Hospital Compare and the corresponding MedPAR patient claims. The study found that every additional patient per nurse was associated with greater odds of mortality, readmission, ICU admission, and greater risk of relative duration of stay. Every 10% increase in compliance of sepsis protocol was only associated with a shorter duration of stay. The study concluded that improvements in nurse staffing and the nurse-to-patient ratios had a greater impact on sepsis infection outcomes than compliance with protocols.
AHRQ-funded; HS026232.
Citation: Dierkes AM, Aiken LH, Sloane DM .
Hospital nurse staffing and sepsis protocol compliance and outcomes among patients with sepsis in the USA: a multistate cross-sectional analysis.
BMJ Open 2022 Mar 22;12(3):e056802. doi: 10.1136/bmjopen-2021-056802..
Keywords: Sepsis, Hospitals, Provider: Nurse, Workforce
Flannery DD, Puopolo KM, Hansen NI
Antimicrobial susceptibility profiles among neonatal early-onset sepsis pathogens.
This retrospective review examined antimicrobial susceptibility of infants ≥22 weeks' gestation who were cared for in Neonatal Research Network centers April 2015-March 2017. Nonsusceptibility was defined as intermediate or resistant on treatment results. The authors identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data was available for 79.1% of isolates. All 81 Gram-positive isolates with ampicillin and gentamicin were susceptible in vitro. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 76.6% isolates were nonsusceptible to ampicillin, 8.5% nonsusceptible to gentamicin, and 7.3% isolates were nonsusceptible to both. The authors estimated that overall 8% of EOS cases were caused by isolates nonsceptible to ampicillin and gentamicin and were most likely to occur among preterm, very-low birth weight infants.
AHRQ-funded; HS027468.
Citation: Flannery DD, Puopolo KM, Hansen NI .
Antimicrobial susceptibility profiles among neonatal early-onset sepsis pathogens.
Pediatr Infect Dis J 2022 Mar;41(3):263-71. doi: 10.1097/inf.0000000000003380..
Keywords: Newborns/Infants, Sepsis, Antibiotics, Medication
Anesi GL, Liu VX, Chowdhury M
Association of ICU admission and outcomes in sepsis and acute respiratory failure.
ICU capacity is strained and its capacity and effectiveness are limited because many patient admission decisions are not evidence-based regarding who benefits from admission triage. The purpose of the study was to measure the benefits of admission to the ICU in patients who were experiencing sepsis or acute respiratory failure. Researchers looked retrospectively from 2013 to 2018 at cohorts within 27 U.S. hospitals across two health systems. They compared ICU admission vs ward admission among patients with sepsis and/ or acute respiratory failure who did not require vasopressors or mechanical ventilation in the emergency department. Study results revealed in patients with sepsis that ICU admission was associated with a hospital stay of 1.32 days longer than ward admissions, with a higher in-hospital mortality ratio. In patients with respiratory failure, ICU admission was associated with a .82-day shorter length of stay and reduced in-patient mortality. Within the two groups, subgroup analysis was conducted, and results revealed that for patients with sepsis, harms were concentrated among older patients and patients with fewer comorbidities. In addition, for patients with respiratory failure, the benefits were concentrated among older patients, patients with higher lab-based acute physiology scores (“high acuity” patients), and patients with comorbidities. The study concluded that among sepsis patients with high acuity scores and not requiring life support in the emergency department, initial admission to the ward was associated with shorter length of stay and improved survival, compared to the same category of patients admitted to the ICU. This result differed from patients with acute respiratory failure, for whom triage to the ICU was associated with improved survival when compared to admission to the ward.
AHRQ-funded; HS026372.
Citation: Anesi GL, Liu VX, Chowdhury M .
Association of ICU admission and outcomes in sepsis and acute respiratory failure.
Am J Respir Crit Care Med 2022 Mar 1;205(5):520-28. doi: 10.1164/rccm.202106-1350OC..
Keywords: Intensive Care Unit (ICU), Sepsis, Respiratory Conditions, Outcomes
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
AHRQ-funded; HS027468.
Citation: Flannery DD, Mukhopadhyay S, Morales KH .
Delivery characteristics and the risk of early-onset neonatal sepsis.
Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
Menon K, Schlapbach LJ, Akech S
Criteria for pediatric sepsis-a systematic review and meta-analysis by the Pediatric Sepsis Definition Taskforce.
This meta-analysis conducted by the Pediatric Sepsis Definition Taskforce determined the associations of demographic, clinical, laboratory, organ dysfunction, and illness severity variable values with sepsis, severe sepsis, or septic shock in children with infection; and multiple organ dysfunction or death in children with sepsis, severe sepsis, or septic shock. Criteria for included studies were case-control studies, cohort studies, and randomized controlled trials in children greater than or equal to 37-week-old postconception to 18 years with suspected or confirmed infection, which included the terms "sepsis," "septicemia," or "septic shock" in the title or abstract. One hundred and six studies met eligibility criteria of which 81 were included. Sixteen studies provided data for the sepsis, severe sepsis, or septic shock outcome and 71 studies for the mortality outcome. Significant and consistent associations with mortality were demonstrated in children with sepsis/severe sepsis/septic shock, chronic conditions, oncologic diagnosis, use of vasoactive/inotropic agents, mechanical ventilation, serum lactate, platelet count, fibrinogen, procalcitonin, multi-organ dysfunction syndrome, Pediatric Logistic Organ Dysfunction score, Pediatric Index of Mortality-3, and Pediatric Risk of Mortality score.
AHRQ-funded; HS025696.
Citation: Menon K, Schlapbach LJ, Akech S .
Criteria for pediatric sepsis-a systematic review and meta-analysis by the Pediatric Sepsis Definition Taskforce.
Crit Care Med 2022 Jan;50(1):21-36. doi: 10.1097/ccm.0000000000005294..
Keywords: Children/Adolescents, Sepsis, Evidence-Based Practice
Alrawashdeh M, Klompas M, Kimmel S
Epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals.
This study examined the epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals from January 2009 to September 2015. This retrospective cohort study looked at about 373 hospitals with a total of 6,715,286 hospitalizations. Using ICD-9 CM codes, 5.6% had sepsis, 1.9% had opioid-related hospitalizations, and 0.1% had both. Patients hospitalized with both diagnoses were younger and healthier, had more bloodstream infections from Gram-positive and fungal pathogens, and had lower in-hospital mortality rates. Of 1,803 patients with opioid-related hospitalizations who died in-hospital, 51.5% had sepsis. From 2009 to 2015, the proportion of sepsis hospitalizations that were opioid-related increased by 77%.
AHRQ-funded; HS025008.
Citation: Alrawashdeh M, Klompas M, Kimmel S .
Epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals.
Crit Care Med 2021 Dec;49(12):2102-11. doi: 10.1097/ccm.0000000000005141..
Keywords: Sepsis, Opioids, Hospitalization
Greenwald E, Olds E, Leonard J
Pediatric sepsis in community emergency care settings: guideline concordance and outcomes.
The authors sought to describe the rate of guideline-concordant care, and hypothesized that guideline-concordant care in community pediatric emergency care settings would be associated with decreased hospital length of stay (LOS). They found that guideline-concordant care was not associated with hospital LOS. The elements that drove overall concordance were timely recognition, vascular access, and timely antibiotics. Emergency care for pediatric sepsis in the community settings studied was concordant with guidelines in only 24% of the cases. They recommended future study to evaluate additional drivers of outcomes and ways to improve sepsis care in community emergency care settings.
AHRQ-funded; HS025696.
Citation: Greenwald E, Olds E, Leonard J .
Pediatric sepsis in community emergency care settings: guideline concordance and outcomes.
Pediatr Emerg Care 2021 Dec;37(12):e1571-e77. doi: 10.1097/pec.0000000000002120..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Guidelines, Evidence-Based Practice
Krutsinger DC, Yadav KN, Harhay MO
A systematic review and meta-analysis of enrollment into ARDS and sepsis trials published between 2009 and 2019 in major journals.
This systematic review and meta-analysis looked at enrollment rates for randomized controlled trials (RCTs) conducted in the ICU, with the focus on patients with acute respiratory distress syndrome (ARDS), acute lung injury (ALI), or sepsis, and which factors influenced enrollment rates. The authors conducted a systematic review using PubMed for ARD/ALI and sepsis to identify individually published RCTs among the seven highest impact general medicine and seven highest impact critical care journals between 2009 and 2019. A total of 457 articles were identified, with 94 trials meeting inclusion criteria. Trials most commonly evaluated were pharmaceutical interventions (53%), were non-industry funded (78%), and required prospective informed consent (81%). The overall enrollment rate was less than 1 participant per site per month, with single-center trials having a significantly higher enrollment rate than multicenter trials. Enrollment for sepsis trials was almost twice the rate as ARDS/ALI.
AHRQ-funded; HS027795.
Citation: Krutsinger DC, Yadav KN, Harhay MO .
A systematic review and meta-analysis of enrollment into ARDS and sepsis trials published between 2009 and 2019 in major journals.
Crit Care 2021 Nov 15;25(1):392. doi: 10.1186/s13054-021-03804-1..
Keywords: Sepsis, Respiratory Conditions
Flannery DD, Edwards EM, Puopolo KM
Early-onset sepsis among very preterm infants.
The purpose of this study was to determine the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants using a nationally representative cohort from academic and community hospitals to inform empirical antibiotic guidance, highlight risk factors for infection, and aid in prognostication for infected infants. Findings showed that, in a nationally representative sample of very preterm infants with EOS from 2018 to 2019, approximately one-third of isolates were neither group B Streptococcus nor E coli. Further, three-quarters of all infected infants either died or survived with a major medical morbidity. Recommendations included the need for novel preventive strategies.
AHRQ-funded; HS027468.
Citation: Flannery DD, Edwards EM, Puopolo KM .
Early-onset sepsis among very preterm infants.
Pediatrics 2021 Oct;148(4). doi: 10.1542/peds.2021-052456..
Keywords: Newborns/Infants, Sepsis
Han X, Spicer A, Carey KA
Identifying high-risk subphenotypes and associated harms from delayed antibiotic orders and delivery.
Delayed antibiotic use can cause harms including mortality in certain novel patient subphenotypes. This study’s objective was to characterize and compare patients who experienced order or delivery delays and identify those novel subphenotypes with elevated risk of harm from delays. Two tertiary care medical centers and four community-based hospitals were analyzed retrospectively from 2008 to 2017. Patient demographics, vitals, laboratory values, medical order and administration times, and in-hospital survival data were obtained from their electronic health records. Order and delivery delays for each admission was calculated. Causal forests, a machine learning method, was used to identify the high-risk subgroup. Out of 60,817 admissions included, delays occurred in 58% of patients. Each additional hour of order delay and delivery delay was associated with increased mortality. A patient subgroup was identified with higher comorbidity burden, greater organ dysfunction, and abnormal initial lactate measures that had a higher risk of death associated with delays.
AHRQ-funded; HS027910; HS026151.
Citation: Han X, Spicer A, Carey KA .
Identifying high-risk subphenotypes and associated harms from delayed antibiotic orders and delivery.
Crit Care Med 2021 Oct;49(10):1694-705. doi: 10.1097/ccm.0000000000005054..
Keywords: Antibiotics, Medication, Sepsis
Page B, Klompas M, Chan C
Surveillance for healthcare-associated infections: hospital-onset adult sepsis events versus current reportable conditions.
US hospitals are required by the Centers for Medicare and Medicaid Services to publicly report central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioidesdiffficile, methicillin-resistant Staphylococcus aureus bacteremia, and selected surgical site infections for benchmarking and pay-for-performance programs. In this study the investigators retrospectively assessed the overlap between HO-ASEs and reportable HAIs among adults hospitalized between June 2015-June 2018 in 3 hospitals.
AHRQ-funded; HS025008.
Citation: Page B, Klompas M, Chan C .
Surveillance for healthcare-associated infections: hospital-onset adult sepsis events versus current reportable conditions.
Clin Infect Dis 2021 Sep 15;73(6):1013-19. doi: 10.1093/cid/ciab217..
Keywords: Sepsis, Healthcare-Associated Infections (HAIs), Hospitals, Clostridium difficile Infections, Catheter-Associated Urinary Tract Infection (CAUTI), Methicillin-Resistant Staphylococcus aureus (MRSA), Central Line-Associated Bloodstream Infections (CLABSI)
Gigli KH, Rak KJ, Hershey TB
A roadmap for successful state sepsis regulations-lessons from New York.
This study looked at the reasons why New York State’s 2013 sepsis regulations were successful in improving mortality compared to less successful sepsis policies at the federal level. The authors recruited thirteen key stakeholders from three groups including four New Year State policymakers and seven clinicians and hospital association leaders involved in the creation and implementation of the 2013 New York State sepsis regulations, as well as two members of patient advocacy groups. The group identified themes related to participant perceptions of the sepsis policy, factors that influenced the policy’s perceived successes, and opportunities for improvement. A major factor that created early buy-in was engaging a diverse array of stakeholders in the development of the policy. Policymakers also worked to provide a balance between the desire for comprehensive reporting and the burden of data collection. The regulations also touched on all three major domains of sepsis quality: structure, process, and outcomes.
AHRQ-funded; HS025146.
Citation: Gigli KH, Rak KJ, Hershey TB .
A roadmap for successful state sepsis regulations-lessons from New York.
Crit Care Explor 2021 Sep;3(9):e0521. doi: 10.1097/cce.0000000000000521..
Keywords: Sepsis, Policy
Garcia MA, Rucci JM, Thai KK
Association between troponin I levels during sepsis and postsepsis cardiovascular complications.
This study examined whether there is an association between elevated serum troponin levels and increased risk for postsepsis cardiovascular complications in patients who had been admitted for sepsis without preexisting cardiovascular disease within 5 years in adults 40 years and older. The patients were admitted with sepsis across 21 hospitals from 2011 to 2017. Peak serum troponin I levels during sepsis were grouped as normal, or tertiles of abnormal from a low of 0.04 to 0.43 ng/ml. Among 14,046 eligible adults, 10.9% had normal troponin levels, as compared to 17.3% at tertile 1, 17.6% at tertile 2, and 20.3% at tertile 3. Patients within the elevated troponin tertiles had increased risks of adverse cardiovascular events.
AHRQ-funded; HS026485.
Citation: Garcia MA, Rucci JM, Thai KK .
Association between troponin I levels during sepsis and postsepsis cardiovascular complications.
Am J Respir Crit Care Med 2021 Sep 1;204(5):557-65. doi: 10.1164/rccm.202103-0613OC..
Keywords: Sepsis, Cardiovascular Conditions, Risk
Mohr NM, Campbell KD, Swanson MB
Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments.
Sepsis is a life-threatening emergency. Together, early recognition and intervention decreases mortality. Protocol-based resuscitation in the emergency department (ED) has improved survival in sepsis patients, but guideline-adherent care is less common in low-volume EDs. This study examined the association between provider-to-provider telemedicine and adherence with sepsis bundle components in rural community hospitals. The investigators found that telemedicine patients were more likely to receive initial blood lactate measurement, timely broad-spectrum antibiotics, and adequate fluid resuscitation.
AHRQ-funded; HS025753.
Citation: Mohr NM, Campbell KD, Swanson MB .
Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments.
J Telemed Telecare 2021 Sep;27(8):518-26. doi: 10.1177/1357633x19896667..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Sepsis
Wayne MT, Seelye S, Molling D
Temporal trends and hospital variation in time-to-antibiotics among veterans hospitalized with sepsis.
It is unclear whether antimicrobial timing for sepsis has changed outside of performance incentive initiatives. The purpose of this study was to examine temporal trends and variation in time-to-antibiotics for sepsis in the US Department of Veterans Affairs (VA) health care system. The investigators concluded that this cohort study found that time-to-antibiotics for sepsis has declined over time. However, there remained significant variability in time-to-antibiotics not explained by patient characteristics, suggesting potential unwarranted practice variation in sepsis treatment.
AHRQ-funded; HS026725.
Citation: Wayne MT, Seelye S, Molling D .
Temporal trends and hospital variation in time-to-antibiotics among veterans hospitalized with sepsis.
JAMA Netw Open 2021 Sep 4(9):e2123950. doi: 10.1001/jamanetworkopen.2021.23950..
Keywords: Sepsis, Veterans
