Introduction: Sepsis is a life-threatening medical emergency and a leading cause of morbidity and mortality worldwide. Reductions in time to antibiotics in patients presenting with sepsis or septic shock are associated with reduced mortality, and Surviving Sepsis Campaign guidelines recommend antibiotics within one hour of recognition. Pharmacists are well-equipped to help navigate the therapeutic and operational challenges associated with achieving this goal.
Objectives: To assess the association of pharmacist involvement in sepsis response with time to antibiotics in hospitalized patients with sepsis and septic shock.
Methods: A systematic review of the following databases was conducted: PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Studies must have included a designated role of an individual pharmacist in the management of sepsis or septic shock and not be considered an operational change. The primary outcome of interest was time to antibiotic administration, with secondary outcomes including intensive care unit (ICU) and hospital length of stay as well as in-hospital mortality.
Results: We identified 10 studies including 1772 patients with sepsis or septic shock that evaluated a sepsis response in which a pharmacist was included. Studies included patients in the ICU, emergency department, and hospital ward setting. Seven studies demonstrated a significant reduction in time to antibiotics, with two other studies supporting this conclusion in extrapolation or sensitivity analysis. There was not a consistent reduction in ICU or hospital length of stay nor in-hospital mortality between those interventions involving a pharmacist compared with their defined control groups.
Conclusion: Pharmacist involvement in sepsis response, often as part of a multi-professional team-based approach to sepsis care, is associated with a reduced time to antibiotic administration for hospitalized patients with sepsis or septic shock.
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http://dx.doi.org/10.1002/jac5.1723 | DOI Listing |
Environ Toxicol
January 2025
Department of Biochemistry, Faculty of Veterinary Medicine, Ataturk University, Erzurum, Turkey.
Sepsis remains the leading cause of multiple-organ injury due to endotoxemia. Astaxanthin (ASTA), widely used in marine aquaculture, has an extraordinary potential for antioxidant and anti-inflammatory activity. Purinergic receptor (e.
View Article and Find Full Text PDFJ Intensive Med
January 2025
Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin, China.
Background: The effect of the modality of hydrocortisone administration on clinical outcomes in patients with septic shock remains uncertain. This systematic review and meta-analysis evaluate the impact of intermittent bolus and continuous infusion of hydrocortisone on these outcomes.
Methods: We searched the PubMed, Embase databases, and Cochrane Library for randomized controlled trials (RCTs) and cohort studies published from inception to January 1, 2023.
J Intensive Med
January 2025
Medical Intensive Care Unit, APHP Saint-Louis University Hospital, Paris, France.
Background: Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity.
View Article and Find Full Text PDFCureus
December 2024
Emergency Medicine, Christiana Care Health System, Newark, USA.
Introduction: Sepsis remains a prevalent critical illness encountered in emergency departments and intensive care units (ICU), with culture-negative sepsis constituting 30-60% of cases. The effect of culture type on treatment and outcomes remains unclear, and conflicting evidence exists regarding disparities between Gram-positive and Gram-negative infections.
Objective: To further describe and compare characteristics and outcomes of culture-positive versus culture-negative sepsis.
Clin Infect Dis
January 2025
Professor of Medicine, Director, Institute for Therapeutic Innovation at University of Florida, Orlando, FL, USA.
Based on the fact that beta-lactam antibiotics demonstrate time-dependent killing, different dosing strategies have been implemented to increase the time that free (f) (unbound) antibiotic concentrations remain above the Minimal Inhibitory Concentration (MIC), including prolonged and continuous infusion. Multiple studies have been performed that compared continuous with traditional intermittent infusion to improve outcomes in patients with severe sepsis and/or septic shock. These studies have yielded inconsistent results for patients as measured by clinical response to treatment and mortality due to heterogeneity of included patients, pathogens, dosing strategies and the absence of Therapeutic Drug Monitoring (TDM).
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