Becker's Clinical Quality & Infection Control

13 INFECTION CONTROL & PATIENT SAFETY New Sepsis Treatment Guidelines: 5 Things to Know By Heather Punke T he Surviving Sepsis Guidelines were first published in 2004, with updates issued in 2008 and 2012. In January, the newest updates were released and published in Critical Care Medi- cine and Intensive Care Medicine. e new guidelines were written by a committee of 55 experts repre- senting 25 international organizations. ey provided 93 recommen- dations on early management of sepsis and septic shock. Here are five things to know about the major changes in the new up- date. 1. e most important changes came in the areas of antibiotic therapy and initial resuscitation, according to a January JAMA article. 2. The new initial resuscitation guidelines now recommend using hemodynamic assessment for further fluid administration as well as for determining the type of shock if the clinical diagnosis does not lead to clear diagnosis. Previously, initial resuscitation guide- lines were based on early goal-directed therapy, which is no longer recommended. 3. New guidelines recommend using dynamic over static vari- ables to predict fluid responsiveness. "This is a significant change," according to the JAMA article. "The guidelines moved from a protocolized, quantitative resuscitation strategy to a more patient-centered resuscitation approach guided by hemodynamic assessment including dynamic variables for fluid responsiveness and ongoing reevaluation of the response to treatment." 4. e updated guidelines call for antibiotics to be administered as soon as possible within one hour, as studies show delay in antibiotic treatment can lead to increased risk of death. 5. e new guidelines also address combination therapy, or using two different classes of antibiotics to cover a pathogen sensitive to both. Doing so is not recommended for routine treatment of neutropenic sepsis, but it can be done with patients who are in septic shock. n Sepsis Causes More Readmissions Than COPD, Heart Failure, Heart Attack and Pneumonia By Brian Zimmerman S epsis — a complication caused by the body's immune response to life-threatening infections — accounts for more readmissions than any of the four conditions CMS tracks for reimbursement purposes, according to a research letter published in JAMA in January. To assess hospital performance, CMS tracks 30-day read- missions following hospitalizations for heart attack, heart failure, chronic obstructive pulmonary disease and pneu- monia. While these conditions occur regularly and account for a substantial amount of readmissions, sepsis-related readmissions are more costly and occur more frequently. To determine the burden of sepsis readmissions on the healthcare system, researchers analyzed data from the 2013 Nationwide Readmissions Database, which doc- uments acute care hospitalizations from 21 states and is representative of inpatient use for 49 percent of the U.S. population. The analysis linked sepsis to 12.2 percent of readmissions, followed by 6.7 percent for heart failure, 5 percent for pneumonia, 4.6 percent for COPD and 1.3 per- cent for heart attack. Researchers estimated the average cost per sepsis read- mission to be $10,070. For pneumonia, the rate was $9,533, followed by $9,424 for heart attack, $9,051 for heart failure and $8,417 for COPD. "This really puts in perspective how important sepsis is," said lead author Florian B. Mayr, MD, faculty member in University of Pittsburgh's department of critical care medicine. "If we, as a nation, place such high emphasis on reducing readmissions for the other four conditions, then we really need to look for opportunities to improve out- comes for sepsis, which has a higher rate of readmission than heart failure. People who survive an initial episode of sepsis often don't do well. They return to the hospital frequently, accrue new health conditions and have signifi- cantly elevated death rates." n Sepsis accounts for more readmissions than any of the four conditions CMS tracks for reimbursement purposes.

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