Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ fa
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ORIGINAL ARTICLE
Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores Junichi Yoshida 1 & Tetsuro Tamura 1 & Kazuhiro Otani 1 & Masaaki Inoue 1 & Eiji Miyatake 1 & Toshiyuki Ishimitsu 1 & Chihiro Nakahara 1 & Masao Tanaka 1 Received: 25 May 2020 / Accepted: 10 September 2020 # The Author(s) 2020
Abstract The difference in sequential organ failure assessment (SOFA) scores from the baseline to sepsis is a known predictor of sepsis-3 outcome, but the prognostic value of drug-resistant organisms for mortality is unexplained. We employed sepsis stewardship and herein report an observational study. Study subjects were patients admitted to the Departments of Surgery/Chest Surgery from 2011 through 2018 with a diagnosis of sepsis and a SOFA score of 2 or more. Our sepsis stewardship methods included antimicrobial and diagnostic stewardship and infection control. We determined the primary endpoint as in-hospital death and the secondary endpoint as the annual trend of the risk-adjusted mortality ratio (RAMR). For mortality, we performed logistic regression analysis based on SOFA score, age, sex, comorbid disease, and the presence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase inhibitor– producing bacteria. In a total of 457 patients, two factors were significant predictors for fatality, i.e., SOFA score of 9 or more with an odds ratio (OR) 4.921 and 95% confidence interval [95% CI] 1.968–12.302 (P = 0.001) and presence of MRSA with an OR 1.83 and 95% CI 1.003–3.338 (P = 0.049). RAMR showed a decrease during the study years (P < 0.05). Early detection of MRSA may help patients survive surgical sepsis-3. Thus, MRSA-oriented diagnosis may play a role in expediting treatment with anti-MRSA antimicrobials. Keywords Sepsis . Methicillin-resistant Staphylococcus aureus . Sequential organ failure assessment score
Introduction Since 2004 in Italy, sepsis stewardship has been defined to integrate the early detection of sepsis and promote education among health service professionals [1]. In 2012, Girardis et al. [2] reviewed six papers on sepsis stewardship programs and stated that early identification and proper management of patients with sepsis were k ey fa c t o r s , a s di d C a va z z ut i a n d o t h e r s [1] . Thereafter, in 2016, sepsis was newly defined as sepsis-3 using an increase in the sequential organ failure assessment (SOFA) score from the baseline SOFA [3].
* Junichi Yoshida [email protected] 1
Department of Surgery/Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki 750-8520, Japan
This change was based on the predictability of its in-hospital prognosis [4]. To reduce the mortality of patients with sepsis, the guidelines proposed early goal-directed therapy (EGDT), including administration of broad-spectrum antimicrobials in the hour bundles [3]. However, antimicrobial and diagnostic stewardship (AS and DS, respectively) have also been advocated since t
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