By the bioMérieux Connection Editors
Administering antimicrobial therapy is essential for treating the underlying infections that cause sepsis, but the protocols for doing so can, at times, clash with antimicrobial stewardship guidelines. A stronger alignment between sepsis protocols and antimicrobial stewardship programs, as well as heightened awareness of the relationship between the two, may help balance these two critical aspects of healthcare.
The timely administration of antimicrobial agents is a vital aspect of sepsis management—it has been used even before the publication of the first sepsis management guidelines. This is because research shows a strong correlation between the time-until-treatment and appropriateness of antimicrobials to mortality in sepsis patients. However, the need to quickly administer effective therapy can lead to clinicians turning to broad-spectrum antimicrobial agents, which can contribute to increased antimicrobial resistance.
Antimicrobial Stewardship in the Management of Sepsis argues that the problem with the rapid initiation of broad-spectrum antibiotics begins with the issue of how to diagnose sepsis. The article notes that current sepsis guidelines may be too general, and lack specificity for not only determining the presence of sepsis but also for determining the occurrence of adverse outcomes. “It is not uncommon for patients with otherwise uncomplicated cases of common infections (e.g., influenza, pneumonia, or pyelonephritis) to meet this widely used definition of sepsis,” it says.
According to an article published in April 2019, “The combination of inadequate diagnostic criteria for sepsis with the extraordinary time pressure to provide broad-spectrum antimicrobial therapy is troubling from a stewardship perspective.” Research shows the need for more effective sepsis management guidelines that better align with the goals of antimicrobial stewardship programs. Increasing awareness about the relationship between the two efforts may be a step in the right direction.
Communicating the Relationship Between Sepsis and Antimicrobial Resistance
Sepsis and antimicrobial resistance (AMR) have a significant relationship. To treat sepsis, physicians must treat the causative infection. If the infection is resistant to antimicrobials, treatment may be difficult or impossible. However, media reporting and/or public health campaigns for sepsis and AMR are rarely presented together, resulting in a lack of understanding of how the issues are related.
Sepsis media reports tend to increase public interest by sharing personal narratives and identifying immediate solutions that are within the power of individual health professionals and the public. This makes them effective in achieving awareness and positive actions. Reports on antimicrobial resistance are often different. AMR is frequently framed as a health threat affecting future patients and involving multiple factors. “Given human decision makers’ tendency to prefer short-term rewards over delayed rewards… this aspect of media reporting does little to encourage individual responsibility or motivation to optimize antimicrobial use,” states the 2019 article. Moreover, individual responsibility can become diffused because AMR messaging calls on everyone at the same time and may not provide concrete steps for a person to take. These aspects each contribute to difficulties in raising awareness and eliciting action.
New Protocols, Diagnostics, & Improved Communication Can Help Align Sepsis Management & Antimicrobial Stewardship
Antimicrobial stewardship strategies, including de-escalation protocols and shortening the duration of antimicrobial treatment, can help align sepsis protocols and stewardship standards. This can help reduce the likelihood of consequences such as C. difficile infections, adverse side effects resulting from prolonged antimicrobial therapy, and contribution to the development of resistant microorganisms.
At the center of these strategies is the clinical laboratory. Around 70% of clinical decisions for patient management are based on laboratory results. Therefore, tools that reduce the time required to detect and identify infection can be especially beneficial. Correctly used, diagnostics can assist clinical decision making, contribute to improved patient outcomes, and strengthen antimicrobial stewardship practices.
Finally, reframing the current AMR message could have an impact on the understanding of the relationship between sepsis and AMR. AMR is an immediate issue with consequences for individual clinicians and patients. It is critical to address AMR in areas like sepsis management, where providing the best patient care makes this challenge both intractable and critical to surmount.
Opinions expressed in this article are not necessarily those of bioMérieux, Inc.