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Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies

1
Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Heath Park Campus, Cardiff CF14 4XN, UK
2
Anaesthetic Directorate, Aneurin Bevan University Health Board, Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP20 2UB, UK
*
Author to whom correspondence should be addressed.
List of the collaborators is included in the acknowledgements.
J. Clin. Med. 2019, 8(9), 1337; https://doi.org/10.3390/jcm8091337
Received: 3 July 2019 / Revised: 7 August 2019 / Accepted: 26 August 2019 / Published: 29 August 2019
Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools. View Full-Text
Keywords: sepsis; antibiotics; microbiology; investigations sepsis; antibiotics; microbiology; investigations
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MDPI and ACS Style

Kopczynska, M.; Sharif, B.; Unwin, H.; Lynch, J.; Forrester, A.; Zeicu, C.; Cleaver, S.; Kulikouskaya, S.; Chandy, T.; Ang, E.; Murphy, E.; Asim, U.; Payne, B.; Nicholas, J.; Waller, A.; Owen, A.; Tan, Z.X.; Ross, R.; Wellington, J.; Amjad, Y.; Unadkat, V.; Hussain, F.; Smith, J.; Ganesananthan, S.; Penney, H.; Inns, J.; Gilbert, C.; Doyle, N.; Kurani, A.; Grother, T.; McNulty, P.; Sharma, A.; Szakmany, T. Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies. J. Clin. Med. 2019, 8, 1337. https://doi.org/10.3390/jcm8091337

AMA Style

Kopczynska M, Sharif B, Unwin H, Lynch J, Forrester A, Zeicu C, Cleaver S, Kulikouskaya S, Chandy T, Ang E, Murphy E, Asim U, Payne B, Nicholas J, Waller A, Owen A, Tan ZX, Ross R, Wellington J, Amjad Y, Unadkat V, Hussain F, Smith J, Ganesananthan S, Penney H, Inns J, Gilbert C, Doyle N, Kurani A, Grother T, McNulty P, Sharma A, Szakmany T. Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies. Journal of Clinical Medicine. 2019; 8(9):1337. https://doi.org/10.3390/jcm8091337

Chicago/Turabian Style

Kopczynska, Maja, Ben Sharif, Harry Unwin, John Lynch, Andrew Forrester, Claudia Zeicu, Sian Cleaver, Svetlana Kulikouskaya, Tom Chandy, Eshen Ang, Emily Murphy, Umair Asim, Bethany Payne, Jessica Nicholas, Alessia Waller, Aimee Owen, Zhao X. Tan, Robert Ross, Jack Wellington, Yahya Amjad, Vidhi Unadkat, Faris Hussain, Jessica Smith, Sashiananthan Ganesananthan, Harriet Penney, Joy Inns, Carys Gilbert, Nicholas Doyle, Amit Kurani, Thomas Grother, Paul McNulty, Angelica Sharma, and Tamas Szakmany. 2019. "Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies" Journal of Clinical Medicine 8, no. 9: 1337. https://doi.org/10.3390/jcm8091337

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