Sepsis bundles likely not associated with improved outcomes

1. Sepsis bundles were not significantly associated with decreased risk of mortality or reduced vasopressor treatment time in community- or hospital-onset sepsis.

2. Components of the SEP-1 bundle, such as broad-spectrum IV antibiotic treatment and lactate levels were associated with improved outcomes in this population.

Evidence Rating Level: 2 (Good)

Sepsis bundles, or protocols involving multiple interventions for care of septic patients, generally focus on community-onset cases presenting to emergency departments. This was the first study to examine the association of the Early Management Bundle for Severe Sepsis/Septic Shock (SEP-1) with mortality in hospital-onset sepsis. This retrospective study occurring at four hospitals included 6,404 patients at least 18 years of age who were diagnosed with sepsis or disseminated infection (M [SD] age = 64.0 [18.2] years, 44.8% female). Defined by SEP-1, exclusion criteria were hospitalization for longer 120 days or less than six days, admission following transfer from another facility, and use of broad-spectrum IV antibiotics for over 24 hours prior the onset of sepsis. Inpatient mortality across the sample was 19.0%, with a median of 7.0 hours spent in the emergency department (IQR 4.9 to 12.6). Regarding mortality and vasopressor days in community-onset sepsis, receipt of SEP-1 was not associated with significant reductions (absolute mortality difference -0.07%, 95% CI -3.02 to 2.88; absolute vasopressor difference 0.31 days, 95% CI 0.11 to 0.51). Lack of significant associations were found among hospital-onset sepsis (absolute mortality difference -0.42%, 95% CI -6.77 to 5.93; absolute vasopressor difference 0.40 days, 95% CI -0.04 to 0.85) and the overall sample (absolute mortality difference 0.10%, 95% CI -2.41 to 2.61; absolute vasopressor difference 0.26, 95% CI 0.09 to 0.43). Specific SEP-1 components were associated with improved outcomes, such as a reduction in mortality risk in community-onset sepsis associated with serum lactate levels (absolute difference -7.61%, 95% CI -14.70 to -0.54). Broad-spectrum IV antibiotics were associated with reduced vasopressor days while, in the hospital-onset group, IV antibiotics reduced risk of mortality (absolute difference -5.20%, 95% CI -9.84 to -0.56). Overall, this study suggests that SEP-1 components can improve outcomes, SEP-1 itself is not associated with reduced risk of mortality or decreased need for vasopressor treatment in septic populations.

Click to read the study in JAMA Internal Medicine

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