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Real world patterns of antimicrobial use and microbiology investigations in patients with sepsis outside the Critical Care Unit: Secondary analysis of three nation-wide point prevalence studies

Kopczynska, Maja, Sharif, Ben, Unwin, Harry, Lynch, John, Forrester, Andrew, Zeicu, Claudia, Cleaver, Sian, Kulikouskaya, Svetlana, Chandy, Tom, Ang, Eshen, Murphy, Emily, Asim, Umair, Payne, Bethany, Nicholas, Jessica, Waller, Alessia, Owen, Aimee, Tan, Zhao Xuan, Ross, Robert, Wellington, Jack, Amjad, Yahya, Unadkat, Vidhi, Hussain, Faris, Smith, Jessica, Ganesananthan, Sashiananthan, Penney, Harriet, Inns, Joy, Gilbert, Carys, Doyle, Nicholas, Kurani, Amit, Grother, Thomas, McNulty, Paul, Sharma, Angelica and Szakmany, Tamas 2019. Real world patterns of antimicrobial use and microbiology investigations in patients with sepsis outside the Critical Care Unit: Secondary analysis of three nation-wide point prevalence studies. Journal of Clinical Medicine 8 (9) , 1337. 10.3390/jcm8091337

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Abstract

Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Publisher: MDPI
ISSN: 2077-0383
Date of First Compliant Deposit: 19 May 2021
Date of Acceptance: 26 August 2019
Last Modified: 21 May 2021 11:30
URI: http://orca.cardiff.ac.uk/id/eprint/141462

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