Abstract
Hospital mortality in patients with severe sepsis and septic shock is still unacceptably high despite advances in understanding of the physiopathology and the numerous clinical trials on potential therapies. Even with optimal treatment, the mortality rate of patients with septic shock exceeds 40 % and has not varied significantly in the last 5 years [1,2]. Early identification and proper management of patients with sepsis are key factors for reducing the observed mortality and have been the main goal of the Surviving Sepsis Campaign (SSC) by the development of evidence-based guidelines and the recommendation of specific bundles of care [3,4]. Some studies have reported a potential benefit on patient outcome by implementing guidelines and bundle care strategies in clinical practice but wide adoption of these approaches is rare. Moreover, it is still unclear whether the observed benefit is more due to the effect of the recommended treatments or to a general increase in the awareness of the sepsis problem as a result of specific educational and stewardship programs.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Esteban A, Frutos-Vivar F, Ferguson ND, et al (2007) Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med 35: 1284–1289
GiVITI (2010) Margherita Project. Available at http://www.giviti.marionegri.it/ Accessed Oct 2011
Dellinger RP, Levy MM, Carlet JM, et al (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 34: 17–60
Dellinger RP, Carlet JM, Masur H, et al (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30: 536–555
Kahn JM, Bates DW (2008) Improving sepsis care: the road ahead. JAMA 299: 2322–2323
Funk D, Sebat F, Kumar A (2009) A systems approach to the early recognition and rapid administration of best practice therapy in sepsis and septic shock. Curr Opin Crit Care 15: 301–307
Shapiro NI, Howell MD, Talmor D, et al (2006) Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med 34: 1025–1032
Nguyen HB, Corbett SW, Steele R, et al (2007) Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 35: 1105–1112
Ferrer R, Artigas A, Levy MM, et al (2008) Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 299: 2294–2303
Castellanos-Ortega A, Suberviola B, Garcia-Astudillo LA, et al (2010) Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study. Crit Care Med 38: 1036–1043
Cardoso T, Carneiro AH, Ribeiro O, Teixeira-Pinto A, Costa-Pereira A (2010) Reducing mortality in severe sepsis with the implementation of a core 6-hour bundle: results from the Portuguese community-acquired sepsis study (SACiUCI study). Crit Care 14:R83
Moro ML RD, Peghetti A, Melotti R (2007) Progetto LaSER Lotta alla sepsi in Emilia-Romagna Razionale, obiettivi, metodi e strumenti. Dossier 143. Available at http://asr.regione.emilia-romagna.it/wcm/asr/collana_dossier/doss143/link/doss143.pdf Accessed Oct 2011
Girardis M, Baricchi R, Caramelli F, et al. (2011) Progetto lotta alla sepsi in Emilia Romagna. Minerva Anestesiol (in press)
Levy MM, Pronovost PJ, Dellinger RP, et al (2004) Sepsis change bundles: converting guidelines into meaningful change in behavior and clinical outcome. Crit Care Med 32:S595–7.
Kumar A, Roberts D, Wood KE, et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34: 1589–1596
Dellit TH, Owens RC, McGowan JE, et al (2007) Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44: 159–177
Levy MM, Dellinger RP, Townsend SR, et al (2010) The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med 36: 222–231
Paul M, Shani V, Muchtar E, Kariv G, Robenshtok E, Leibovici L (2010) Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother 54: 4851–4863
Pea F, Viale P (2009) Bench-to-bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock—does the dose matter? Crit Care 13: 214
Ziglam HM, Morales D, Webb K, Nathwani D (2006) Knowledge about sepsis among training-grade doctors. J Antimicrob Chemother 57: 963–965
Pulcini C, Williams F, Molinari N, Davey P, Nathwani D (2011) Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clin Microbiol Infect 17: 80–87
McKinley BA, Moore LJ, Sucher JF, et al (2011) Computer protocol facilitates evidencebased care of sepsis in the surgical intensive care unit. J Trauma 70: 1153–1166
Hitti EA, Lewin JJ, 3rd, Lopez J, et al (2011) Improving door-to-antibiotic time in severely septic emergency department patients. J Emerg Med 2011 Jul 5. [Epub ahead of print]
Barochia AV, Cui X, Vitberg D, et al. (2010) Bundled care for septic shock: an analysis of clinical trials. Crit Care Med 38: 668–78.
Ferrer R, Artigas A, Suarez D, et al (2009) Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study. Am J Respir Crit Care Med 180: 861–866
Reinhart K, Brunkhorst FM, Bone HG, et al (2010) Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinare Vereinigung fur Intensiv-und Notfallmedizin (DIVI)). Ger Med Sci 8: Doc14
Alejandria MM, Lansang MA, Dans LF, Mantaring JB (2002) Intravenous immunoglobulin for treating sepsis and septic shock. Cochrane Database Syst Rev CD001090
Laupland KB, Kirkpatrick AW, Delaney A (2007) Polyclonal intravenous immunoglobulin for the treatment of severe sepsis and septic shock in critically ill adults: a systematic review and meta-analysis. Crit Care Med 35: 2686–2692
Kreymann KG, de Heer G, Nierhaus A, Kluge S (2007) Use of polyclonal immunoglobulins as adjunctive therapy for sepsis or septic shock. Crit Care Med 35: 2677–2685
Girardis M, Rinaldi L, Donno L, et al (2009) Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study. Crit Care 13: R143
Cavazzuti I RL, Donno L, Braccini S, Busani S, Girardis M (2010) Early use of immunoglobulin in septic shock. Crit Care 14: P25
Berlot G, Vassallo MC, Busetto N, et al (2012) Relationship between the timing of administration of IgM and IgA enriched immunoglobulins in patients with severe sepsis and septic shock and the outcome: A retrospective analysis. J Crit Care (in press)
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Girardis, M., Busani, S., Pan, A. (2012). Sepsis Stewardship Programs: Methods and Results. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2012. Annual Update in Intensive Care and Emergency Medicine, vol 2012. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25716-2_12
Download citation
DOI: https://doi.org/10.1007/978-3-642-25716-2_12
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-25715-5
Online ISBN: 978-3-642-25716-2
eBook Packages: MedicineMedicine (R0)