NIHR Signal Adding the extra antibiotic rifampicin did not improve cure rates after sepsis

NIHR Signal Adding the extra antibiotic rifampicin did not improve cure rates after sepsis
Published on 17 April 2018


Adding the antibiotic rifampicin did not improve cure rates or reduce deaths for people with bacterial blood infections caused by Staphylococcus aureus.
https://discover.dc.nihr.ac.uk/content/signal-00584/adding-the-extra-antibiotic-rifampicin-did-not-improve-cure-rates-after-sepsis


From the NIHR Dessemination Centre

NIHR Signal Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis

The risk of death in adults with sepsis was 30% lower when each dose of antibiotic was given intravenously over three hours compared to a bolus or less than 60 minutes.


This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins.


From the Dissemination Centre

NIHR Signal Blood test could shorten antibiotic treatment in newborns with suspected sepsis

Measuring procalcitonin levels in newborns with suspected sepsis in the first days of life reduced antibiotic duration by 10 hours compared with standard care. There was no increase in the risk of re-infection or death.

Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but results of the blood culture takes time.

From the NIHR Dissemination Centre

Sepsis [QS161]

New NICE quality standard covers the recognition, diagnosis and early management of sepsis for all populations. It describes high-quality care in priority areas for improvement.

Sere also Sepsis guidance implementation advice for adults and the Cross-system sepsis action plan 2017 from NHS England.

New improvements to help fight sepsis

Thousands of nurses, care home staff and pharmacists will be told how to check for signs and symptoms of sepsis, as part of a new NHS plan to improve treatment of the condition.

In septic patients requiring fluid resuscitation can the bedside lung ultrasound be used to assess the pulmonary fluid status?

In septic patients requiring fluid resuscitation can the bedside lung ultrasound be used to assess the pulmonary fluid status? In patients presenting to the emergency department with severe sepsis requiring fluid resuscitation the use of lung ultrasound for determining the pulmonary fluid status remains unknown. The current data supporting this practice is missing. A coming prospective observational study will better document this clinical question by measuring the effect of fluid bolus with lung ultrasound in children diagnosed with sepsis.

Severe Sepsis and Septic Shock: Clinical Audit 2016/17

This Royal College of Emergency Medicine audit shows an improvement in the proportion of patients receiving the best care for severe sepsis and septic shock, but that improvements are needed to make treatment available faster.

Sepsis: quality standard Draft for consultation

This DRAFT quality standard on sepsis from NICE is expected to contribute to improvements in rates of mortality, long-term disability, and organ failure, and in length of hospital or ICU stay in people with sepsis.

Kissing Goodbye Sepsis at James Paget University Hospital

Case study from James Paget University about reducing length of stay for septic patients.

Giving antibiotics immediately reduces deaths from sepsis

Giving immediate antibiotics (defined as within one hour) when people present to emergency departments with suspected sepsis reduces their risk of dying by a third compared with later administration.

From the NIHR Dissemination Centre

Resources to support delivery of ‘Reducing the impact of serious infection’ CQUIN

NHS Improvement and Public Health England have developed resources to support providers and commissioners in the delivery of the national ‘Reducing the impact of serious infections (Antimicrobial Resistance and Sepsis)’ CQUIN.

The resources include a series of FAQs, tools for data collections and baseline data, and are available via the NHS Improvement website or on the CQUIN webpage.

Treat life-threatening sepsis within the hour, says NICE

In a new draft quality standard, NICE says people showing signs of sepsis must be checked carefully. Once someone is classed as high-risk they should be seen by senior staff and given the right treatment within an hour.

In septic patients requiring fluid resuscitation does the bedside lung ultrasound be used to assess the pulmonary fluid status?

In [critically ill patients presenting to the emergency department with sepsis requiring fluid resuscitation], does [bedside lung ultrasound or b-lines assessment] be used to determine the [pulmonary fluid status]?

In patients presenting to the emergency department with severe sepsis requiring fluid resuscitation the use of lung ultrasound for determining the pulmonary fluid status remains unknown. The current data supporting this practice is missing. A coming prospective observational study will better document this clinical question by measuring the effect of fluid bolus with lung ultrasound in children diagnosed with sepsis.

The cost of sepsis care

The Sepsis Trust has published its report on the cost of sepsis care in the UK.

New electronic screening for sepsis to be trialled in Nottingham

Nottingham University Hospitals NHS Trust is piloting a new electronic sepsis screening procedure after the trust moved away from paper records in 2015. Each nurse, junior doctor and healthcare assistant will have a mobile device to carry out screenings under the scheme. The device will use an early warning score system based on the updated sepsis criteria from the National Institute of Health and Care Excellence (NICE).

Reducing sepsis and saving lives

NHS Improvement spoke to Joan Pons Laplana, Transformation Nurse at James Paget University Hospitals NHS Foundation Trust, to find out how he has helped to reduce the incidents of death caused by sepsis at the trust by putting some simple and low-cost new measures in place.

International Guidelines for Management of Sepsis and Septic Shock

Revised guidelines on the management of sepis and septic shock by the Surviving Sepsis Campaign (SSC), Society of Critical Care Medicine (SCCM), and European Society of Intensive Care Medicine (ESICM)

Peripheral Metaraminol Infusion in the Emergency Department

New from BestBETs

In [adult patients presenting to the Emergency Department with sepsis resulting in persistent hypotension not responding to fluid replacement] is a [peripheral metaraminol infusion as effective as central noradrenaline infusion] for [maintaining a blood pressure capable of effective organ perfusion]

There is currently insufficient evidence to support the use of peripheral metaraminol as vasopressor support in the emergency department. A randomised multi-centre controlled trial should be performed with adult patients to establish definitively whether the use of a peripheral metaraminol infusion is safe and feasible as vasopressor support in patients who attend the emergency department with persistent hypotension secondary to sepsis unresponsive to adequate fluid resuscitation.

One dose per day compared to multiple doses per day of gentamicin for treatment of suspected or proven sepsis in neonates

The objective of this study was to compare the efficacy and safety of one dose per day compared to multiple doses per day of gentamicin in suspected or proven sepsis in neonates.  There is insufficient evidence from the currently available RCTs to conclude whether a 'once a day' or a 'multiple doses a day' regimen of gentamicin is superior in treating proven neonatal sepsis. However, data suggest that pharmacokinetic properties of a 'once a day' gentamicin regimen are superior to a 'multiple doses a day' regimen in that it achieves higher peak levels while avoiding toxic trough levels. There was no change in nephrotoxicity or auditory toxicity. Based on the assessment of pharmacokinetics, a 'once a day regimen' may be superior in treating sepsis in neonates of more than 32 weeks' gestation.

The heart failure drug levosimendan doesn’t improve outcomes in adults with severe infections

Septic shock is a life-threatening condition resulting from serious infection.

Adding levosimendan to the usual care of adults with septic shock did not reduce the risk of death up to 28 days, nor the degree of damage to essential body organs. It probably also increased patients’ risk of abnormally fast heart rate and increased the time they needed mechanical ventilation.

From the NIHR Dissemination Centre