title: Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit.
abstract: BACKGROUND
  A study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes.
  
  
  METHODS
  Quasi-experimental observational retrospective study.
  
  
  METHODS
  Polyvalent 11 beds ICU belonging to a tertiary Universitary hospital.
  
  
  METHODS
  Patients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock.
  
  
  METHODS
  A post intervention group (POST-SC) (September 2012-August 2013) was compared with a historical group (PRE-SC) used as control (January-December 2010).
  
  
  METHODS
  Antibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays.
  
  
  RESULTS
  42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p<0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p=0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p=0,035) and 31% vs 56% (p=0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p=0,05).
  
  
  CONCLUSIONS
  The implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay.
authors: Servicio de Farmacia, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors: L
authors: L
authors: García-López
authors: Servicio de Farmacia, Hospital del Mar, Barcelona, España.
authors: S
authors: S
authors: Grau-Cerrato
authors: Servicio de Farmacia, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors: A
authors: A
authors: de Frutos-Soto
authors: Unidad de Cuidados Intensivos, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors: F
authors: F
authors: Bobillo-De Lamo
authors: Unidad de Cuidados Intensivos, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors: R
authors: R
authors: Cítores-Gónzalez
authors: Unidad de Cuidados Intensivos, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors: F
authors: F
authors: Diez-Gutierrez
authors: Sección de Metodología y Bioestadística, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors: M F
authors: MF
authors: Muñoz-Moreno
authors: Servicio de Farmacia, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors: T
authors: T
authors: Sánchez-Sánchez
authors: Unidad de Cuidados Intensivos, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors: F
authors: F
authors: Gandía-Martínez
authors: Unidad de Cuidados Intensivos, Hospital Clínico Universitario de Valladolid, Valladolid, España. Electronic address: dandaluz@saludcastillayleon.es.
authors: D
authors: D
authors: Andaluz-Ojeda
mesh_terms: D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002985:Clinical Protocols; D019468:Disease Management; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality; D013030:Spain; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Antibióticos; ICU; Mortalidad; Mortality; Sepsis; UCI