Sepsis and Antimcrobial Stewardship: Are they really mutually Exclusive?

Transcription

1 Sepsis and Antimcrobial Stewardship: Are they really mutually Exclusive? DR KATE ADAMS CONSULTANT INFECTIOUS DISEASES HULL AND EAST YORKSHIRE NHS TRUST AMS Sepsis

2 No!

3 At least not if the sepsis programme is run properly

4 4 point plan for AMS and Sepsis programme harmony u Always ensure a good AMS programme is running first u Make patient safety rather than CQUIN achievement your focus u Target the right patients u Target the antibiotics

5 4 point plan for AMS and Sepsis programme harmony u Always ensure a good AMS programme is running first u Make patient safety rather than CQUIN achievement your focus u Target the right patients u Target the antibiotics

6 4 point plan for AMS and Sepsis programme harmony u Always ensure a good AMS programme is running first u Make patient safety rather than CQUIN achievement your focus u Target the right patients u Target the antibiotics

7 Point 2: Patient safety rather than CQUIN focus u Sepsis pathway that combines screening and patient management u Extensive education programme u Focus on deteriorating patient rather than just sepsis

8 Sepsis Pathway

9 Point 2: The Sepsis 6 u Give oxygen u Take blood cultures u Take bloods including a blood for lactate u Give IV antibiotics u Give IV fluids u Take a urine sample and monitor urine output

10 Point 2: The Sepsis 6 u Give oxygen u Take blood cultures u Take bloods including a blood for lactate u Give IV antibiotics u Give IV fluids u Take a urine sample and monitor urine output u Review and de-escalate

11 Blood Culture Taking in HEYHT 2100 Number of Blood Cultures 2016 /

12 4 point plan for AMS and Sepsis programme harmony u Always ensure a good AMS programme is running first u Make patient safety rather than CQUIN achievement your focus u Target the right patients u Target the antibiotics

13 Sepsis SIRS plus infection Mortality 10 15% Systemic Inflammatory Response Syndrome (SIRS) 2 of following: Temp > 38 C or < 36 C Pulse > 90bpm RR > 20bpm WCC > or < 4000 / mmᶟ or > 10% band forms Severe Sepsis SIRS plus evidence of Infection plus organ dysfunction Septic Shock SIRS plus evidence of Infection plus organ dysfunction plus refractory hypotension Mortality 15 25% Mortality 40 55%

14 Sepsis SIRS plus infection Mortality 10 15% Systemic Inflammatory Response Syndrome (SIRS) 2 of following: Temp > 38 C or < 36 C Pulse > 90bpm RR > 20bpm WCC > or < 4000 / mmᶟ or > 10% band forms Severe Sepsis SIRS plus evidence of Infection plus organ dysfunction Septic Shock SIRS plus evidence of Infection plus organ dysfunction plus refractory hypotension Mortality 15 25% Mortality 40 55%

15 Sepsis Infection SIRS plus infection Mortality 10 15% Systemic Inflammator y Response Syndrome (SIRS) 2 of following: Temp > 38 C or < 36 C Pulse > 90bpm RR > 20bpm WCC > or < 4000 / mmᶟ or > 10% band forms Severe Sepsis Life threatening organ dysfunction due to a dysregulated host response to infection Septic Shock Subset of patients with Sepsis in which particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality Mortality 15 25% Mortality 40 55%

16 Sepsis Infection SIRS plus infection Mortality 10 15% Systemic Inflammator y Response Syndrome (SIRS) 2 of following: Temp > 38 C or < 36 C Pulse > 90bpm RR > 20bpm WCC > or < 4000 / mmᶟ or > 10% band forms Severe Sepsis Life threatening organ dysfunction due to a dysregulated host response to infection Septic Shock Subset of patients with Sepsis in which particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality Mortality 15 25% Mortality 40 55%

17 Point 3: Target the right patients u There is time to think and assess properly in the vast majority of patients with infection u The only evidence for urgent (broad spectrum) antibiotics is in patients with septic shock

18 Time from onset of hypotension to effective antibiotic therapy Kumar A et al. Crit Care Med 2006; 34 (6):

19 4 point plan to a good sepsis programme u Always ensure a good AMS programme is running first u Make patient safety rather than CQUIN achievement your focus u Target the right patients u Target the antibiotics

20 Point 4: Target the antibiotics u If you know the source of an infection targeting the common causes of infection in that area is better than giving blind broad spectrum antibiotics u To do this you need to know the resistance patterns of bacterial isolates in your Trust u You need strong antibiotic guidelines

21 HSMR for non obstetric sepsis in HEYHT Sepsis Team starts

22 Piperacillin/Tazobactam and Carbapenems Quarterly Trends 2014/15 to 2016/ HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST Inpatient Antibiotic Usage (DDD/1000 Admissions) (includes In-Patient, Stock items, TTO pre-packs and IDLs. No Out-Patient data included) - Quarterly Report DDD/1000 Admissions - Agents of Concern Piperacillin / Tazobactam Meropenem Ertapenem Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr4

23 Conclusions u Sepsis programmes can run in harmony with antimicrobial stewardship programmes u A strong antimicrobial programme must come first u The sepsis programme needs to be targeted and run by someone that understands infection management

24 Any Questions?