Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department

Pierluigi Viale, Sara Tedeschi, Luigia Scudeller, Luciano Attard, Lorenzo Badia, Michele Bartoletti, Alessandra Cascavilla, Francesco Cristini, Nicola Dentale, Giovanni Fasulo, Giorgio Legnani, Filippo Trapani, Fabio Tumietto, Gabriella Verucchi, Giulio Virgili, Andrea Berlingeri, Simone Ambretti, Chiara De Molo, Mara Brizi, Mario CavazzaMaddalena Giannella

Research output: Contribution to journalArticle

Abstract

Background: The impact on patient survival of an infectious disease (ID) team dedicated to the early management of severe sepsis/septic shock (SS/SS) in Emergency Department (ED) has yet to be assessed. Methods: A quasiexperimental pre-post study was performed at the general ED of our hospital. During the pre phase (June 2013-July 2014), all consecutive adult patients with SS/SS were managed according to the standard of care, data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team performing a bedside patient evaluation within 1 hour of ED arrival. Results: Overall, 382 patients were included, 195 in the pre phase and 187 in the post phase. Median age was 82 years (interquartile range, 70-88). The most common infection sources were lung (43%) and urinary tract (17%); in 22% of cases, infection source remained unknown. During the post phase, overall compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P < .001) and from 30% to 79% (P < .001), respectively. Multivariate analysis showed that predictors of all-cause 14-day mortality were quick sepsis-related organ failure assessment ≥2 (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.15-2.45; P = .007), serum lactate ≥2 mmol/L (HR, 2.13; 95% CI, 1.39-3.25; P < .001), and unknown infection source (HR, 2.07; 95% CI, 1.42-3.02; P < .001); being attended during the post phase was a protective factor (HR, 0.64; 95% CI, 0.43-0.94; P = .026). Conclusion: Implementation of an ID team for the early management of SS/SS in the ED improved the adherence to SSC recommendations and patient survival.

Original languageEnglish
Pages (from-to)1253-1259
Number of pages7
JournalClinical Infectious Diseases
Volume65
Issue number8
DOIs
Publication statusPublished - Oct 1 2017

Fingerprint

Septic Shock
Communicable Diseases
Hospital Emergency Service
Sepsis
Confidence Intervals
Infection
Survival
Standard of Care
Urinary Tract
Lactic Acid
Multivariate Analysis
Anti-Bacterial Agents
Lung
Mortality
Serum

Keywords

  • Emergency department
  • Infectious disease consultant
  • Mortality
  • Sepsis
  • Septic shock

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department. / Viale, Pierluigi; Tedeschi, Sara; Scudeller, Luigia; Attard, Luciano; Badia, Lorenzo; Bartoletti, Michele; Cascavilla, Alessandra; Cristini, Francesco; Dentale, Nicola; Fasulo, Giovanni; Legnani, Giorgio; Trapani, Filippo; Tumietto, Fabio; Verucchi, Gabriella; Virgili, Giulio; Berlingeri, Andrea; Ambretti, Simone; De Molo, Chiara; Brizi, Mara; Cavazza, Mario; Giannella, Maddalena.

In: Clinical Infectious Diseases, Vol. 65, No. 8, 01.10.2017, p. 1253-1259.

Research output: Contribution to journalArticle

Viale, P, Tedeschi, S, Scudeller, L, Attard, L, Badia, L, Bartoletti, M, Cascavilla, A, Cristini, F, Dentale, N, Fasulo, G, Legnani, G, Trapani, F, Tumietto, F, Verucchi, G, Virgili, G, Berlingeri, A, Ambretti, S, De Molo, C, Brizi, M, Cavazza, M & Giannella, M 2017, 'Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department', Clinical Infectious Diseases, vol. 65, no. 8, pp. 1253-1259. https://doi.org/10.1093/cid/cix548
Viale, Pierluigi ; Tedeschi, Sara ; Scudeller, Luigia ; Attard, Luciano ; Badia, Lorenzo ; Bartoletti, Michele ; Cascavilla, Alessandra ; Cristini, Francesco ; Dentale, Nicola ; Fasulo, Giovanni ; Legnani, Giorgio ; Trapani, Filippo ; Tumietto, Fabio ; Verucchi, Gabriella ; Virgili, Giulio ; Berlingeri, Andrea ; Ambretti, Simone ; De Molo, Chiara ; Brizi, Mara ; Cavazza, Mario ; Giannella, Maddalena. / Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 8. pp. 1253-1259.
@article{b88e05d92e124aa695e5cd659b5af23d,
title = "Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department",
abstract = "Background: The impact on patient survival of an infectious disease (ID) team dedicated to the early management of severe sepsis/septic shock (SS/SS) in Emergency Department (ED) has yet to be assessed. Methods: A quasiexperimental pre-post study was performed at the general ED of our hospital. During the pre phase (June 2013-July 2014), all consecutive adult patients with SS/SS were managed according to the standard of care, data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team performing a bedside patient evaluation within 1 hour of ED arrival. Results: Overall, 382 patients were included, 195 in the pre phase and 187 in the post phase. Median age was 82 years (interquartile range, 70-88). The most common infection sources were lung (43{\%}) and urinary tract (17{\%}); in 22{\%} of cases, infection source remained unknown. During the post phase, overall compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6{\%} to 32{\%} (P < .001) and from 30{\%} to 79{\%} (P < .001), respectively. Multivariate analysis showed that predictors of all-cause 14-day mortality were quick sepsis-related organ failure assessment ≥2 (hazard ratio [HR], 1.68; 95{\%} confidence interval [CI], 1.15-2.45; P = .007), serum lactate ≥2 mmol/L (HR, 2.13; 95{\%} CI, 1.39-3.25; P < .001), and unknown infection source (HR, 2.07; 95{\%} CI, 1.42-3.02; P < .001); being attended during the post phase was a protective factor (HR, 0.64; 95{\%} CI, 0.43-0.94; P = .026). Conclusion: Implementation of an ID team for the early management of SS/SS in the ED improved the adherence to SSC recommendations and patient survival.",
keywords = "Emergency department, Infectious disease consultant, Mortality, Sepsis, Septic shock",
author = "Pierluigi Viale and Sara Tedeschi and Luigia Scudeller and Luciano Attard and Lorenzo Badia and Michele Bartoletti and Alessandra Cascavilla and Francesco Cristini and Nicola Dentale and Giovanni Fasulo and Giorgio Legnani and Filippo Trapani and Fabio Tumietto and Gabriella Verucchi and Giulio Virgili and Andrea Berlingeri and Simone Ambretti and {De Molo}, Chiara and Mara Brizi and Mario Cavazza and Maddalena Giannella",
year = "2017",
month = "10",
day = "1",
doi = "10.1093/cid/cix548",
language = "English",
volume = "65",
pages = "1253--1259",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "NLM (Medline)",
number = "8",

}

TY - JOUR

T1 - Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department

AU - Viale, Pierluigi

AU - Tedeschi, Sara

AU - Scudeller, Luigia

AU - Attard, Luciano

AU - Badia, Lorenzo

AU - Bartoletti, Michele

AU - Cascavilla, Alessandra

AU - Cristini, Francesco

AU - Dentale, Nicola

AU - Fasulo, Giovanni

AU - Legnani, Giorgio

AU - Trapani, Filippo

AU - Tumietto, Fabio

AU - Verucchi, Gabriella

AU - Virgili, Giulio

AU - Berlingeri, Andrea

AU - Ambretti, Simone

AU - De Molo, Chiara

AU - Brizi, Mara

AU - Cavazza, Mario

AU - Giannella, Maddalena

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background: The impact on patient survival of an infectious disease (ID) team dedicated to the early management of severe sepsis/septic shock (SS/SS) in Emergency Department (ED) has yet to be assessed. Methods: A quasiexperimental pre-post study was performed at the general ED of our hospital. During the pre phase (June 2013-July 2014), all consecutive adult patients with SS/SS were managed according to the standard of care, data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team performing a bedside patient evaluation within 1 hour of ED arrival. Results: Overall, 382 patients were included, 195 in the pre phase and 187 in the post phase. Median age was 82 years (interquartile range, 70-88). The most common infection sources were lung (43%) and urinary tract (17%); in 22% of cases, infection source remained unknown. During the post phase, overall compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P < .001) and from 30% to 79% (P < .001), respectively. Multivariate analysis showed that predictors of all-cause 14-day mortality were quick sepsis-related organ failure assessment ≥2 (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.15-2.45; P = .007), serum lactate ≥2 mmol/L (HR, 2.13; 95% CI, 1.39-3.25; P < .001), and unknown infection source (HR, 2.07; 95% CI, 1.42-3.02; P < .001); being attended during the post phase was a protective factor (HR, 0.64; 95% CI, 0.43-0.94; P = .026). Conclusion: Implementation of an ID team for the early management of SS/SS in the ED improved the adherence to SSC recommendations and patient survival.

AB - Background: The impact on patient survival of an infectious disease (ID) team dedicated to the early management of severe sepsis/septic shock (SS/SS) in Emergency Department (ED) has yet to be assessed. Methods: A quasiexperimental pre-post study was performed at the general ED of our hospital. During the pre phase (June 2013-July 2014), all consecutive adult patients with SS/SS were managed according to the standard of care, data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team performing a bedside patient evaluation within 1 hour of ED arrival. Results: Overall, 382 patients were included, 195 in the pre phase and 187 in the post phase. Median age was 82 years (interquartile range, 70-88). The most common infection sources were lung (43%) and urinary tract (17%); in 22% of cases, infection source remained unknown. During the post phase, overall compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P < .001) and from 30% to 79% (P < .001), respectively. Multivariate analysis showed that predictors of all-cause 14-day mortality were quick sepsis-related organ failure assessment ≥2 (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.15-2.45; P = .007), serum lactate ≥2 mmol/L (HR, 2.13; 95% CI, 1.39-3.25; P < .001), and unknown infection source (HR, 2.07; 95% CI, 1.42-3.02; P < .001); being attended during the post phase was a protective factor (HR, 0.64; 95% CI, 0.43-0.94; P = .026). Conclusion: Implementation of an ID team for the early management of SS/SS in the ED improved the adherence to SSC recommendations and patient survival.

KW - Emergency department

KW - Infectious disease consultant

KW - Mortality

KW - Sepsis

KW - Septic shock

UR - http://www.scopus.com/inward/record.url?scp=85032794385&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032794385&partnerID=8YFLogxK

U2 - 10.1093/cid/cix548

DO - 10.1093/cid/cix548

M3 - Article

AN - SCOPUS:85032794385

VL - 65

SP - 1253

EP - 1259

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 8

ER -