Correct sepsis classification-A must for antimicrobial stewardship: A longitudinal observational study

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Pharmacology

Background:

• Sepsis presents a significant global health challenge, demanding early recognition and precise intervention for effective management.
• Accurate sepsis diagnosis is essential for guiding appropriate treatment and promoting antimicrobial stewardship.
• Low- and middle-income countries bear a disproportionate burden of sepsis morbidity and mortality.

Purpose of the Study:

• To evaluate the distribution of sepsis categories and empirical antibiotic use within the WHO AWaRe system in a Northern Indian tertiary care hospital.
• To investigate the correlation between antibiotic usage and sepsis classifications.
• To inform antimicrobial stewardship and optimize treatment strategies.

Main Methods:

• A longitudinal observational study conducted from 2023-2024 in a tertiary care hospital in Northern India.
• Patients with suspected sepsis were categorized into sepsis classes (Asepsis, Possible, Probable, Confirmed) and followed for 28 days or until discharge.
• Descriptive and inferential statistics were used to analyze sepsis categories and WHO AWaRe antibiotic usage.

Main Results:

• Of 230 patients meeting inclusion criteria, initial classifications were predominantly probable (51.3%) and possible sepsis (35.7%).
• Final classification shifted towards asepsis (57.8%), with all patients receiving antibiotics.
• Empirical antibiotic use heavily favored the WHO Watch group (72.2%), with ceftriaxone and piperacillin-tazobactam most common, but no significant association with sepsis class was found.

Conclusions:

• Precise sepsis classification is vital for clinical decisions, optimizing antibiotic use, and combating antimicrobial resistance.
• A significant number of patients initially suspected of sepsis were treated empirically, indicating a need for improved diagnostic accuracy.
• High utilization of 'Watch' group antibiotics necessitates enhanced diagnostic tools to refine empirical therapy and reduce unnecessary antibiotic exposure, supporting antimicrobial stewardship.