Hospital Onset Clostridium difficile Infections Increased With Electronic Sepsis Alerts Interview with:

Dr. Robert Hiensch MD Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai

Dr. Hiensch

Dr. Robert Hiensch MD
Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine
Icahn School of Medicine at Mount Sinai. What is the background for this study? What are the main findings?

Response: New sepsis guidelines that recommend screening and early treatment for sepsis cases appear to have significant positive impacts on patient outcomes. Less research has been published on what potential side effects may result from these guidelines.

Antibiotics are a cornerstone of sepsis treatment and early antibiotic administration is strongly recommended.  We examined whether the introduction of an electronic based sepsis initiative changed antibiotic prescribing patterns at our hospital. Antibiotics, even when appropriate, contribute to hospital onset Clostridium difficile infections (HO CDIs).  While the authors do not dispute the importance of antibiotic administration in sepsis, it is valuable to know whether the sepsis initiative coincided with both increased antibiotic administration and HO CDIs.

Our study was a single institution retrospective time series analysis conducted from data collected from June 2011-2014. Demographic, antibiotic administration, and HO CDI data were collected from several medical wards before, during, and after the implementation of our electronic sepsis initiative, a program which was launched to improve sepsis outcomes through a multidisciplinary approach by early recognition and timely multimodality therapy, including early and broad antibiotic administration.

The main findings were that antibiotic use increased during the period of implementation and the period after implementation compared with the baseline, pre-implementation period. Surprisingly, the increase was not driven by any individual antibiotic that was part of the “sepsis order set,” but by levofloxacin. We speculate that this may be because levofloxacin was used as the drug of choice when antibiotics were being narrowed or converted to PO. Hospital onset Clostridium difficile infections mirrored that of antibiotic prescribing: increasing during and after implementation. Since this was an observational, retrospective study, these findings cannot be said to be causative. We did not examine other patient level outcomes, such as overall sepsis mortality, which generally has decreased at our hospital since the introduction of the sepsis initiative. What should clinicians and patients take away from your report? What recommendations do you have for future research as a result of this study?

Response: The main takeaway for readers should be that the introduction of an electronic sepsis initiative correlated with changes in antibiotic prescribing patterns and Hospital onset Clostridium difficile infections rates. We cannot infer causality, but our findings warrant further research into unintended consequences of sepsis screening and treatment programs as they are implemented into hospitals nationwide. Identifying potential side effects is the first step to further improve these initiatives in an effort to save more patient lives.

Disclosures: The authors have no disclosures. Thank you for your contribution to the community.

Citation:Robert Hiensch, Jashvant Poeran, Patricia Saunders-Hao, Victoria Adams, Charles A. Powell, Allison Glasser, Madhu Mazumdar, Gopi Patel. Impact of an electronic sepsis initiative on antibiotic use and health care facility–onset Clostridium difficile infection rates. American Journal of Infection Control, 2017; 45 (10): 1091 DOI: 10.1016/j.ajic.2017.04.005

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on October 18, 2017 by Marie Benz MD FAAD