Impacto de la implantación de un Código Sepsis intrahospitalario en la prescripción de antibióticos y los resultados clínicos en una unidad de cuidados intensivos / Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit

INTRODUCCIÓN: Se analiza el impacto de un Código Sepsis intrahospitalario sobre el uso y consumo de antibióticos, la estancia hospitalaria y la mortalidad. DISEÑO: Estudio retrospectivo cuasiexperimental observacional. Ámbitos: UCI polivalente de 11 camas en un hospital de tercer nivel. PACIENTES: Pacientes ingresados en UCI con diagnóstico de sepsis grave o shock séptico. INTERVENCIONES: Un grupo postintervención (POST-CS) (septiembre 2012-agosto 2013) se comparó con un grupo histórico (PRE-CS) control (enero-diciembre 2010). VARIABLES: Tipo de tratamiento antibiótico, estrategia terapéutica antibiótica y resultados clínicos. El consumo de antibióticos fue expresado en dosis diarias definidas/100 estancias. RESULTADOS: Se incluyeron 42 pacientes con sepsis grave/shock séptico en el grupo POST-CS y 50 en el grupo PRE-CS. El consumo total de antibióticos (dosis diarias definidas) fue similar en ambos grupos. En el grupo POST-CS la tasa de desescalamiento fue significativamente mayor (75 vs. 30,8%, p < 0,005), mientras que la prescripción de antibióticos de uso restringido fue significativamente menor (74 vs. 52%, p = 0,031). Finalmente, el grupo de pacientes POST-CS presentó una mortalidad intrahospitalaria y a 28 días significativamente menor (23 vs. 44% [p = 0,035] y 31 vs. 56% [p = 0,01]), así como una disminución de la estancia en UCI en el límite de la significación estadística (5 vs. 10,5 días, p = 0,05). CONCLUSIÓN: La implantación de un programa de Código Sepsis intrahospitalario se asoció a una mejor utilización del tratamiento antibiótico, incrementándose significativamente el desescalamiento terapéutico y disminuyendo el uso de antibióticos de uso restringido, así como a una significativa disminución de la mortalidad y una tendencia hacia una menor estancia en UCI

INTRODUCTION: A study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes. DESIGN: Quasi-experimental observational retrospective study. SETTING: Polyvalent 11 beds ICU belonging to a tertiary Universitary hospital. PATIENTS: Patients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock. INTERVENTIONS: A post intervention group (POST-SC) (September 2012-August 2013) was compared with a historical group (PRE-SC) used as control (January-December 2010). VARIABLES: Antibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays. RESULTS: 42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p < 0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p = 0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p = 0,035) and 31% vs 56% (p = 0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p = 0,05). CONCLUSION: The implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay

Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit. / Impacto de la implantación de un Código Sepsis intrahospitalario en la prescripción de antibióticos y los resultados clínicos en una unidad de cuidados intensivos.

INTRODUCTION: A study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes. DESIGN: Quasi-experimental observational retrospective study. SETTING: Polyvalent 11 beds ICU belonging to a tertiary Universitary hospital. PATIENTS: Patients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock. INTERVENTIONS: A post intervention group (POST-SC) (September 2012-August 2013) was compared with a historical group (PRE-SC) used as control (January-December 2010). VARIABLES: Antibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays. RESULTS: 42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p<0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p=0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p=0,035) and 31% vs 56% (p=0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p=0,05). CONCLUSION: The implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay.

[Analysis of early tracheostomy and its impact on development of pneumonia, use of resources and mortality in neurocritically ill patients]. / Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos.

OBJECTIVE: We analyze the most suitable time to perform tracheostomy in neurocritically ill patients. We compare morbimortality and use of resources between those patients in which tracheostomy was done early (9 days), in a selected group of patients. MATERIAL AND METHODS: We made an observational prospective study involving a group of patients diagnosed as traumatic brain injury (TBI) or stroke, whose tracheostomy was performed during their stay at the Intensive Care Unit. We compared two groups: a) early tracheostomy (during first 9 days of ICU stay); b) late tracheostomy (made on 10th day or later). As variables, we studied: demographic data, severity of illness at admission, admittance department, diagnosis, length of intubation, length of mechanical ventilation (LMV), sedation and antibiotic treatment needs, ventilator-associated pneumonia (VAP) events, ICU length of stay and mortality. We calculated relative risk of suffering from pneumonia and made a multivariate logistic regression to establish which factors were associated with an increased risk of developing pneumonia. Statistical signification p

Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos / Analysis of early tracheostomy and its impact on development of pneumonia, use of resources and mortality in neurocritically ill patients

Objetivos. Analizar el momento más adecuado parala realización de la traqueotomía en enfermos neurocríticos,comparando en una población seleccionadade pacientes las diferencias de morbimortalidad yconsumo de recursos entre el grupo en que se realizó latraqueotomía precozmente (≤9 días) y aquéllos en losque fue más tardía (>9 días).Material y métodos. Estudio prospectivo y observacionalen una población de pacientes con diagnósticode traumatismo craneoencefálico (TCE) o accidentecerebrovascular (ACVA) que precisaron traqueotomíadurante su ingreso en UCI. Se compararon los datosen dos grupos de pacientes: a) traqueotomía precoz(TP) en los primeros 9 días; b) traqueotomía tardía(TT) a partir del 10º día. Variables estudiadas: datosdemográficos, gravedad al ingreso, procedencia, diagnóstico,duración de la intubación orotraqueal (IOT)y de la ventilación mecánica (VM), necesidades desedación y de antibioterapia, frecuencia de neumoníaasociada a ventilación mecánica (NAV), duración de laestancia y mortalidad. Se calculó el riesgo relativo depadecer neumonía y un modelo de regresión logísticamultivariante para determinar los factores asociadosal desarrollo de neumonía. Significación estadísticapara una p≤0.05.Resultados. Se estudiaron 118 pacientes, 60% conTCE. La media de IOT previa a la traqueotomía (TRQ)fue de 12 días y la duración de la VM de 20 días. Sediagnosticaron 94 episodios de NAV en 81 pacientes(68.6%). El grupo de TP muestra menor duración de laVM, de la sedación, de la antibioterapia y de la estanciaen UCI, con menor incidencia de neumonía (p<0.001).La precocidad de la TRQ no influyó en la duración de laestancia hospitalaria (p=0.844), ni en la mortalidad enUCI (p=0.924), ni en la hospitalaria (p=0.754). La mediade edad fue menor en el grupo con TCE (p<0.001),además la TRQ se realiza más tarde (p=0.026) y requieren (..) (AU)

Objective. We analyze the most suitable time to performtracheostomy in neurocritically ill patients. Wecompare morbimortality and use of resources betweenthose patients in which tracheostomy was done early(≤ 9 days) and those in which it was perform later (>9days), in a selected group of patients.Material and methods. We made an observationalprospective study involving a group of patients diagnosedas traumatic brain injury (TBI) or stroke, whosetracheostomy was performed during their stay at theIntensive Care Unit. We compared two groups: a) earlytracheostomy (during first 9 days of ICU stay); b) latetracheostomy (made on 10th day or later). As variables,we studied: demographic data, severity of illness atadmission, admittance department, diagnosis, lengthof intubation, length of mechanical ventilation (LMV),sedation and antibiotic treatment needs, ventilatorassociatedpneumonia (VAP) events, ICU length of stayand mortality. We calculated relative risk of sufferingfrom pneumonia and made a multivariate logisticregression to establish which factors were associatedwith an increased risk of developing pneumonia. Statisticalsignification p < 0.05.Results. We analyzed 118 patients, 60% with TBI.Mean length of intubation before tracheostomy was 12days and mean LMV was 20 days. 94 VAP events werediagnosed in 81 patients (68.6%). Early tracheostomygroup showed lower length of mechanical ventilationand ICU stay, lower length of sedation and antibiotictreatment, and less pneumonia events (p<0,001). Theprecocity of tracheostomy didn’t have any influenceeither on hospital length of stay (p=0.844), ICU mortality(p=0.924) or in-hospital mortality (p=0.754). At theTBI group mean age was lower (p<0.001), tracheostomywas made later (p=0.026), and patients needed a longersedation (p=0.001) and a longer antibiotic treatment(..) (AU)