Evaluation of empiric antibiotic use in surgical sepsis.

BACKGROUND: We performed an evaluation of antimicrobial guidelines for patients with surgical sepsis. METHODS: The purpose of this study was to validate current empiric antibiotic recommendations in our sepsis protocol based on the suspected site of infection. The primary objective was to assess the appropriateness of empiric antibiotic recommendations and to determine if initial empiric antibiotics provided adequate coverage compared with sensitivity data (accuracy). Secondary end points included antibiotic protocol compliance, intensive care unit (ICU)-free days, and mortality. RESULTS: Appropriate antibiotics were prescribed in 82% of patients. Of the culture-positive patients, 72% received accurate antibiotics. ICU-free days were greater for patients in the compliant group (14.5 vs 8.4; P = .014). Hospital mortality was greater in patients who were noncompliant with protocol recommendations (22% vs 17%; P = .44). CONCLUSIONS: Our current antibiotic guidelines provide appropriate and accurate antimicrobial coverage. Noncompliance with the antibiotic protocol resulted in fewer ICU-free days and increased hospital mortality in surgical sepsis patients.

Computerized clinical decision support improves mortality in intra abdominal surgical sepsis.

BACKGROUND: The management of surgical sepsis is challenging because of the complexity of interventions. The authors therefore created a computerized clinical decision support program to facilitate this process, with the goal of improving abdominal sepsis mortality. METHODS: The authors evaluated a prospective database for all patients requiring surgery for abdominal sepsis. Patient demographics, Acute Physiology and Chronic Health Evaluation II score, sepsis source, and hospital mortality data were obtained. Observed mortality was compared with predicted mortality using Fisher's exact test. RESULTS: Eighty-seven patients met the inclusion criteria. The average age was 59 ± 17.0 years, and 39% were men. The most common source of infection was the colon (45%). The average Acute Physiology and Chronic Health Evaluation II score was 27.6 ± 9.72. The overall actual mortality rate for the cohort was 24% compared with a predicted Acute Physiology and Chronic Health Evaluation II mortality of 62.5% (P < .0001). CONCLUSION: The use of computerized clinical decision support results in significantly improved survival in patients with intra-abdominal surgical sepsis.