Sepsis: Early infectious disease consultation saves lives

27 December, 2019

A recent study on the acute management of patients with severe sepsis and septic shock revealed that infectious disease (ID) consultation within 12 hours after patients’ arrival at the hospital is associated with a 40% reduction in in-hospital mortality risk.¹

Sepsis is a life-threatening medical emergency associated with a serious risk of morbidity and mortality.² An early intervention by the emergency department (ED) team is crucial to improve the clinical outcomes of sepsis. The Surviving Sepsis Campaign guidelines recommend a sepsis care bundle, which includes appropriate diagnostic investigations, administration of antibiotics and the management of hypotension.³ An earlier involvement of ID physician may also improve the outcomes of sepsis as demonstrated in several studies of hospitalised ID patients.^4–7

Recently, a group of experts conducted a study to evaluate the impact of ID consultation within the first 12 hours after ED triage on clinical outcomes and antibiotics prescribing in patients with severe sepsis and septic shock who completed the standard sepsis care bundle (N=248).¹ The study assessed in-hospital mortality, 30-day readmission, length of hospital stay, and antibiotics management in patients who received ID consultation (n=111) and those who only received standard care (n=137).

The researchers reported that the rate of in-hospital mortality was significantly lower in patients who received ID consultation compared with patients who only received standard care (24.3% versus 38.0%; adjusted odd ratio, 0.47; 95% CI, 0.25–0.89; p=0.02).¹ An early ID consultation was found to be protective of in-hospital mortality (adjusted subdistribution hazard ratio, asHR, 0.60; 95% CI, 0.36–1.00; p=0.0497) and predictive of discharge alive (asHR, 1.58; 95% CI, 1.11–2.23; p=0.01).¹

In a time-to-event analysis, the time to de-escalation of antibiotics was found to be shorter in patients with ID consultation than those without it (log-rank test, p=0.07).¹ The researchers also noted that there were no significant differences in 30-day readmission, median hospital length of stay or median days of antibiotic therapy.

In a hospital that provides ID consultation for 24-hour daily, a sepsis case may be referred to an ID physician within the first few hours after the patient’s arrival. However, in hospitals that are unable to afford the 24/7 ID consultation model due to limited resources, an ID consultation within the first 12 hours after a patient’s arrival is achievable and should be considered in view of a significant improvement in clinical outcomes – particularly in increasing survival rate. In addition, involvement of ID physicians can also improve collaborative relationships with ED physicians and physicians’ compliance to the sepsis care bundle.