Tag Archives: antibiotics

Congress Session Addresses Antibiotic Stewardship in Sepsis

A session during the 46th Critical Care Congress addressed balancing early antibiotic administration and stewardship in sepsis.

At the start of the session, Mitchell Levy, MD, MCCM, notes the importance of the topic. “Through the Surviving Sepsis Campaign … we’ve produced sepsis performance metrics, which have now been adopted nationally by [the Centers for Medicare & Medicaid Services]. They mandate rapid institution of appropriate antibiotics for all patients suspected of sepsis within the first hour.”

That’s the good news. The bad news, according to Dr. Levy, is that “we live in a time of serious concerns about antibiotics resistance.” He noted many people say “the performance measures may have… unintended deleterious consequences by driving antibiotics into patients that turn out later to not have infections. That’s often been used as the reason to not to adhere to or accept the performance measures.”

The Society of Critical Care Medicine has been collaborating with the Centers for Disease Control and Prevention (CDC) and has been in conversation with the American College of Emergency Physicians (ACEP) and the Infectious Diseases Society of America (IDSA) to address this issue.

“We’ve come to see how to balance this by marrying the rapid institution of appropriate antibiotics with antibiotic stewardship,” Dr. Levy said. Panelists discussed the drive to make early antibiotics effective while minimizing how long patients receive antibiotics.

Panelists took questions from the audience and debated several questions, including whether the goals of integrating antibiotic stewardship with the rapid treatment of severe sepsis and septic shock were mutually exclusive. The group discussed practical and lesser-known benefits of a robust antibiotic stewardship program, and how to balance rapid antibiotic choices while still protecting against antimicrobial resistance.

Panelists included Lauren Epstein, MD, from the CDC, Tiffany Osborn, MD, MPH, FCCM, FACEP, representing the ACEP, and Stephen Weber, MD, representing the IDSA. The session aimed to review coordination and staging of timely antibiotic administration and to recognize the impact that antibiotic resistance has in clinical medicine and sepsis.

Dr. Epstein, along with Surviving Sepsis Campaign founder, R. Phillip Dellinger, MD, MCCM, served as guest panelists during the Critical Connections Live broadcast on the New Guidelines for the Management of Sepsis and Septic Shock.

The updated Surviving Sepsis Campaign guidelines (available in both Critical Care Medicine and Intensive Care Medicine) were released during the 46th Critical Care Congress, along with a viewpoint and synopsis published in JAMA. Materials are available at www.survivingsepsis.org.

Affiliated materials released in conjunction with the guidelines include:

Sign-on Letter: Detect and Protect Against Antibiotic Resistance Initiative

The Society of Critical Care Medicine (SCCM) recently signed onto a letter regarding the U.S. Centers for Disease Control and Prevention (CDC) Detect and Protect Against Antibiotic Resistance Initiative.

The letter urges the U.S. Congress to appropriate $30 million included in the Fiscal Year 2015 President’s Budget Request for the Detect and Protect Against Antibiotic Resistance Initiative. The initiative is part of a CDC strategy to achieve measurable results in combating the public health crisis of rapidly rising antibiotic resistance. The time to act is now, the letter states, while there is still an opportunity to prevent a post-antibiotic era in which we are unable to successfully treat infections or carry out many other healthcare activities (e.g., transplants and other surgeries, chemotherapy, care of preterm infants) currently made safe and possible by effective antibiotics.

Other letters that SCCM signed onto in 2014 are:

AMA Protecting Access to Medicare Act of 2014

AMA SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/S. 2000)

AMA SGR Repeal and Medicare Provider Payment Modernization Act of 2014

IDSA ADAPT Act Letter

ACP CSS Meaningful Use Letter

You can also view the  2013 letters receiving Society support.

The Society is asked to sign onto letters addressing upcoming rules, payment policies, regulation, performance measurement, clinical topics, and other matters in cooperation with a variety of organizations. SCCM also issues letters of comment independently as the Council and Executive Committee deem important to patients and membership.

CDC Urges Better Antibiotic Stewardship

A new Vital Signs report from the Centers for Disease Control and Prevention (CDC) shows that clinicians in some hospitals prescribe three times as many antibiotics than clinicians in other hospitals, even though patients were receiving care in similar areas of each hospital. In addition, about one-third of the time, prescribing practices to treat urinary tract infections and prescriptions for the critical and common drug vancomycin included a potential error – given without proper testing or evaluation, or given for too long. The report also found that, in hospitals, a 30% reduction in use of the antibiotics that most often cause deadly diarrheal infections with Clostridium difficile can reduce these infections by more than 25%. The same antibiotics also prime patients for future super-resistant infections.

To help hospitals develop antibiotic stewardship programs, CDC released practical tools that include seven key elements, a self-assessment checklist, and an in-depth implementation document.

The Vital Signs report follows several calls to action from CDC on antibiotic resistance including the Antibiotic Resistance Threats to the United States, 2013 report, the Get Smart about Antibiotics Week, and the upcoming coming Transatlantic Taskforce on Antimicrobial Resistance 2013 report.

Optimize Antibiotic Timing and Dosing for Sepsis

Studies have demonstrated that timely administration of appropriate antibiotics reduces mortality in patients with severe sepsis. Proper selection of antibiotics that provide broad coverage and adequate dosing to achieve therapeutic concentrations are essential to positive outcomes. A team-based approach to protocol-initiated antibiotics, including a representative from pharmacy, can optimize time-to-antibiotic and appropriate selection and dosing, thereby improving patient care.

The Society of Critical Care Medicine’s (SCCM) webcast, Antibiotics and Sepsis: Appropriate Timing and Dosage, will take place on August 7, 2013, at 1:00 p.m. Central Time. Diana Wells, PharmD, BCPS, and Jeffrey Fish, PharmD, BCPS, will provide evidence and case-based information to achieve early and optimal impact from antimicrobial agents in sepsis patients. At the conclusion of this webcast, participants should be able to:

  • Summarize literature that supports appropriate choice and timing of antibiotics in sepsis
  • Using a patient case, develop an antimicrobial dosing regimen to achieve early and optimal exposure to appropriate antimicrobial agents
  • Recognize patient factors that may affect antibiotic dosing for patients with severe sepsis or septic shock

This event, part of SCCM’s Surviving Sepsis Campaign (SSC) webcast series, provides strategies for successful application of the SSC guidelines. This webcast was developed in collaboration with the SCCM Pharmacy Section. An initiative of the European Society of Intensive Care Medicine (ESICM) and SCCM, the SSC aims to improve the management, diagnosis and treatment of sepsis in order to reduce its high mortality rate.

Register online today. Registration is complimentary for all participants. No CME is available. If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.