Severe sepsis and septic shock treatment - antibiotics optimization (under construction)

A living systematic review

Short url: http://openmetaanalysis.github.io/sepsis/

Clinical summary: This meta-analysis suggests that selected clinical intervention may be effective. Heterogeneity of results as measured by I² was 'substantial' at 86%. The heterogeneity may be due to varying levels of patient acuity across studies as reflected in differing levels of mean lactic acid and age in the cohorts. Heterogeneity may also be due to varying cutoffs across studies for defining rapid adminstration of fluids. This review updates previously published meta-analysis(es).

Non-randomized studiesof de-escalation may be biased by patients who were de-escalated were not as sick (PMID 27493799,31560686).

Subgroup analysis suggested a trend that was insignificant.

• Reconciliation of studies and conclusions with prior meta-analyses
• Keep current with this topic

Acknowledgement: we acknowledge the essential work by the authors of the prior systematic review(s) listed below.

Methods overview: This repository is an openMetaAnalysis that combines methods of scoping, rapid, and living systematic reviews. This analysis updates one or more previously published review(s) below. A comparison of studies included in this review compared to prior reviews are in the table, reconciliation of trials included with prior meta-analyses/. Newer studies included are listed in the references below. Rationale for newer trials excluded may be listed at the end of the references.

• Methods for openMetaAnalysis
• Evidence search for this review

Results: Details of the studies included are in the:

• Reconciliation of studies and conclusions with prior meta-analyses
• Description of studies (PICO table) (under construction)
• Risk of bias assessment (Clarity) (under construction)
• Forest plots (source data)

The forest plot for the primary outcomes are below. Additional forest plots of secondary analyses may be available.

The meta-regression for the primary outcomes are below. Additional meta-regressions of secondary analyses may be available.

References:

Systematic review(s)

Most recent review at time of last revision of this repository

1. Guo Y, Gao W, Yang H, Ma C, Sui S. De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis. Heart Lung. 2016 Sep-Oct;45(5):454-9. doi: 10.1016/j.hrtlng.2016.06.001. Epub 2016 Jun 20. PMID: 27340006.

Studies

New studie(s) not included in the most recent review above

1. Leone M, Bechis C, Baumstarck K, Lefrant JY, Albanèse J, Jaber S, Lepape A, Constantin JM, Papazian L, Bruder N, Allaouchiche B, Bézulier K, Antonini F, Textoris J, Martin C; AZUREA Network Investigators. De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial. Intensive Care Med. 2014 Oct;40(10):1399-408. doi: 10.1007/s00134-014-3411-8. Epub 2014 Aug 5. Erratum in: Intensive Care Med. 2014 Nov;40(11):1794. PMID: 25091790.
2. Rashidzada Z, Cairns KA, Peel TN, Jenney AW, Doyle JS, Dooley MJ, Cheng AC. Early antimicrobial stewardship team intervention on appropriateness of antimicrobial therapy in suspected sepsis: a randomized controlled trial. JAC Antimicrob Resist. 2021 Aug 27;3(3):dlab097. doi: 10.1093/jacamr/dlab097. PMID: 34458731.
3. Madaline T, Wadskier Montagne F, Eisenberg R, Mowrey W, Kaur J, Malik M, Gendlina I, Guo Y, White D, Pirofski LA, Sarwar U. Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle. Open Forum Infect Dis. 2019 Oct 31;6(10):ofz408. doi: 10.1093/ofid/ofz408. PMID: 31687417.

Studie(s) included in the review above

Not applicable

Studie(s) undergoing review

1. Pending

Studie(s) excluded - selected list of important trial(s)

1. Schmitt S, McQuillen DP, Nahass R, Martinelli L, Rubin M, Schwebke K, Petrak R, Ritter JT, Chansolme D, Slama T, Drozd EM, Braithwaite SF, Johnsrud M, Hammelman E. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs. Clin Infect Dis. 2014 Jan;58(1):22-8. doi: 10.1093/cid/cit610. Epub 2013 Sep 25. PMID: 24072931. Event rates in subpopulations with sepsis or septic shock not reported
2. Roper S, Wingler MJB, Cretella DA. Antibiotic De-Escalation in Critically Ill Patients with Negative Clinical Cultures. Pharmacy (Basel). 2023 Jun 16;11(3):104. doi: 10.3390/pharmacy11030104. PMID: 37368430. Less than half of patients had sepsis.
3. Francis M, Rich T, Williamson T, Peterson D. Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis. CJEM. 2010 Jul;12(4):303-10. doi: 10.1017/s1481803500012380. PMID: 20650022. Had ED mortality, but not hospital or 30-day mortality.
4. Liu P, Ohl C, Johnson J, Williamson J, Beardsley J, Luther V. Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program. BMC Infect Dis. 2016 Dec 12;16(1):751. doi: 10.1186/s12879-016-2080-3. PMID: 27955625. Less thkan 50% septic and mortality for the septic subgroup not reported

Cited by

This repository is cited by:

1. WikiDoc contributors. Pending content page. WikiDoc. Nov 9, 2014. Available at: http://www.wikidoc.org/index.php/This_topic. Accessed November 9, 2014.

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