Improved Empirical Antibiotic Treatment of Sepsis After an Educational Intervention: The ABISS-Edusepsis Study

Ferrer R, Martínez ML, Gomà G, et al. Crit Care. 2018 Jun 22;22(1):167. [CrossRef] [PubMed]

Early appropriate antibiotic treatment is essential in sepsis. The authors evaluated the impact of a multifaceted educational intervention to improve antibiotic treatment. They prospectively studied all 2628 consecutive patients with sepsis/septic shock admitted to 72 intensive care units (ICUs) throughout Spain in two 4-month periods (before and immediately after the 3-month intervention). In the postintervention cohort, the mean (SD) time from sepsis onset to empirical antibiotic therapy was lower (2.0 (2.7) vs. 2.5 (3.6) h; p = 0.002), the proportion of inappropriate empirical treatments was lower (6.5% vs. 8.9%;p = 0.024), and the proportion of patients in whom antibiotic treatment was de-escalated was higher (20.1% vs. 16.3%; p = 0.004); the expected reduction in mortality did not reach statistical significance (29.4% in the postintervention cohort vs. 30.5% in the preintervention cohort; p = 0.544). The educational intervention is poorly described and the gains in time to empirical antibiotic therapy and inappropriate antibiotic are modest and did not result in an improvement in mortality. These make the authors’ conclusions that “educational interventions can still improve the delivery of care” uncertain.