Thread by @HalliePrescott

Thread on recent @JAMAInternalMed study:

jamanetwork.com/journals/jamai…

This work was done in partnership with Dr. Vinnie Liu of @KPDOR, with funding from @AHRQNews, support from @vahsrd, and led by our awesome teams @VA_CCMR & @KPDOR. I can't say thank you enough for the support and to the awesome teams behind this work.

#Sepsis Guidelines, QI programs, and performance evaluation all recommend and/or incentivize prompt antimicrobial treatment for sepsis because earlier time-to-treatment is associated with improved outcomes.

However, it can be difficult to diagnosis sepsis with certainty in real-time, as @iwashyna and I have written about before

https://twitter.com/HalliePrescott/status/1112757285665861632

atsjournals.org/doi/full/10.15…

Thus, many have worried that incentivizing rapid treatment for sepsis may lead to antibiotic overuse, including antibiotic use in patients without infection or with nonbacterial infection, and lead to abx resistance and side-effects.

However, while many studies have examined the impact of time-to-treatment in patients with sepsis ... there is scant data on the impact of time-to-treatment on all-comers at-risk for sepsis.

In this study we examined temporal trends in time-to-antibiotics for sepsis (CDC surveillance defn) and and abx use in patients at-risk for sepsis (SIRS+).

The 152 hospitals in our cohort delivered abx faster over time (as we previously showed in VA): jamanetwork.com/journals/jaman…

At the same time, antibiotic use among all-comers at-risk for sepsis decreased.

There was a small decline in % treated w/in 48 hours, and larger declines in days treated and % treated w/ broad-spectrum coverage.

Mortality and MDR pathogens also decreased.

THIS IS GREAT NEWS!

Beyond exploring cohort-wide trends, we also examined hospital-specific trends to further assess whether accelerated time-to-treatment was potentially driving antibiotic overuse in a subset of hospitals.

In figure 2, we present scatterplots showing individual hospitals plotted by yearly change in time-to-abx for sepsis (x-axis) and change in abx use in all SIRS+ hospitalizations (y-axis).

I've highlighted in green to show that most hospitals were able to simultaneously give abx faster in sepsis and give fewer days of therapy (inclusive of abx prescribed at hospital discharge) among all-comers at risk-for sepsis.

This study is really good news.

Sepsis and antimicrobial stewardship are often viewed as in conflict, but this study shows that gains can be made simultaneously in both.

You can read more about this study here:
ihpi.umich.edu/news/antibioti…

and here:
spotlight.kaiserpermanente.org/early-antibiot…