title: Antimicrobial Stewardship in the Management of Sepsis.
abstract: Sepsis represents a unique clinical dilemma with regard to antimicrobial stewardship. The standard approach to suspected sepsis in the emergency department centers on fluid resuscitation and timely broad-spectrum antimicrobials. The lack of gold standard diagnostics and evolving definitions for sepsis introduce a significant degree of diagnostic uncertainty that may raise the potential for inappropriate antimicrobial prescribing. Intervention bundles that combine traditional quality improvement strategies with emerging electronic health record-based clinical decision support tools and rapid molecular diagnostics represent the most promising approach to enhancing antimicrobial stewardship in the management of suspected sepsis in the emergency department.
authors.affiliation: Emergency Medicine Antimicrobial Stewardship Program, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, Madison, WI 53705, USA. Electronic address: mspulia@medicine.wisc.edu.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pulia
authors.affiliation: Antibiotic Stewardship Committee, Divine Savior Healthcare, 2817 New Pinery Road, Portage, WI 53901, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Redwood
authors.affiliation: The American Center, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, Madison, WI 53705, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Sharp
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002985:Clinical Protocols / Q000592:standards; D020000:Decision Support Systems, Clinical; D024881:Drug Resistance, Bacterial; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000592:standards; D006801:Humans; D050316:Medical Order Entry Systems; D061214:Patient Safety / Q000592:standards; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Antimicrobial stewardship; Biomarkers; Clinical decision support; Emergency medicine; Quality measures; Rapid pathogen identification assays; Sepsis