Why the Sepsis Clinical Pathway and antimicrobial stewardship (AMS) go hand in hand

Friday, August 23, 2019

When intravenous antibiotics are the only specific medical treatment for sepsis, how can we promote sepsis awareness and early identification without encouraging antibiotic overuse?

Queensland’s Could this be sepsis? program has prioritised antimicrobial stewardship (AMS) from the beginning, with two infectious diseases experts on the Statewide Sepsis Steering Committee providing advice and guidance on the development of the adult and paediatric clinical pathways.

Dr Adam Irwin, Senior Lecturer at UQ and Academic Lead for Paediatric Infectious Disease at the Queensland Children’s Hospital said while time to antibiotics was vitally important for children, risks have to be mitigated.

‘We need to ensure antibiotics are properly targeted at those children who are most likely to benefit while mitigating potential harm to other children being assessed for sepsis.’

‘The Paediatric Sepsis Clinical Pathway has been specifically designed to effectively screen children for sepsis to consciously rule it out; thereby only administering antibiotics to children with confirmed sepsis.’

Dr Irwin said other countries had mandated that children with suspected sepsis are given antibiotics within one hour, which he said carries unintended risks.

‘The one-hour timeframe is appropriate for children with sepsis and septic shock, but not when sepsis is only suspected or there are vague signs.’

Dr Kathryn Wilks, Infectious Diseases and Medical Microbiologist, Sunshine Coast University Hospital, and Senior Lecturer at UQ, is also on the steering committee.

‘AMS is an extremely important issue, especially for adults who are very likely to be returning to hospital repeatedly.’ 

‘The strong AMS consideration from the beginning led to the development of easy to use and focussed antibiotic guidelines for the adult pathway, which are tailored for hospitals depending on their antibiotic resistance patterns - which is a first for Australia and elsewhere.’ 

‘The adult guidelines are also unique in that they provide more assistance for ED doctors who need to treat septic shock quickly or have patients with several possible sources of infection.  The guidelines also provide easy instruction for administration of antibiotics.’

Dr Wilks said importantly, the outcomes of the sepsis program are being measured not only in success of reduced hospital stay, avoidance of ICU and reduced mortality, but also in the appropriate use of broad-spectrum antibiotics.

‘We want to focus on ensuring that the most unwell patients get the best treatment quickly without causing long-term harm and encouraging the review of antibiotics after patients leave ED to ensure they remain well on the wards.’

For more information, visit Queensland’s Could this be sepsis? program page

Last updated: 23 August 2019