Sepsis initiatives may hinder antibiotic stewardship, boost C. diff rates

Sepsis screening and treatment protocols in healthcare settings may inadvertently cause increased antibiotic use and Clostridium difficile infection rates, according to a study published in the American Journal of Infection Control.

For the study, researchers assessed data on adult inpatients at four medicine wards at a large, tertiary academic medical center from June 2011 to July 2014. Researchers examined patient outcomes and treatment before, during and after the hospital implemented a sepsis initiative, which included electronic screening, laboratory tests and possible antibiotic treatment. The sepsis initiative allowed for the administration of broad-spectrum antibiotics without preauthorization from an antibiotic stewardship team.

Both antibiotic use and hospital-acquired C. diff infection rates increased during and after the sepsis initiative implementation. The main drivers of overall antibiotic use were not included in the sepsis order set.

"Integrated sepsis care streamlines how treatment is delivered. Yet as our research indicates, providers face the tough task of addressing how to deliver timely sepsis care, while mitigating potential unintended consequences such as an increase in healthcare facility-onset Clostridium difficile infection that may be linked to increased use of broad-spectrum antibiotics," said lead author Jashvant Poeran, MD, PhD, an assistant professor at the Icahn School of Medicine at Mount Sinai in New York City. "Hospitals' antibiotic stewardship teams can use these observations to align protocol with processes that ensure appropriate antibiotic administration."

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