Description
Consider the quality improvement topic you chose last week.Discuss where you would find appropriate evidence-based guidelines to implement a quality improvement initiative related to this topic.Search the Herzing library for a peer reviewed quantitative primary research study that supports the change you would like to consider. Include an appropriate link or PDF of the study.Discuss the connections of the evidence-based guidelines with the peer reviewed research.Please be sure to validate your opinions and ideas with citations and references in APA format.
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Sepsis / Septic Shock: Immediate Versus Early Antibiotic
Administration
Search date
05/07/2022
Author
Kylie Porritt BN, GradDipNursSc(Cardiac), MNSc, PhD
updated by Sandeep Moola PhD
Publication date
15/08/2022
Question
What is the best available evidence regarding the effectiveness and safety of immediate versus early
antibiotics for patients with severe sepsis and/or septic shock?
Clinical Bottom Line
Sepsis is a clinical syndrome characterized by systemic inflammation due to infection and is recognized as
a medical emergency.1,2 Each year across the world, there are approximately 49 million cases of sepsis
and 11 million deaths from sepsis.1 Early recognition and management of sepsis is critical. The
administration of antibiotics is a crucial component of sepsis management, with evidence suggesting
antibiotic therapy is associated with a decrease in mortality.1,2 However, debates exist on the timing of
antibiotic administration and its impacts on patient outcomes.
The administration of immediate antibiotic therapy (zero to one hour) compared to early antibiotic therapy
(one to three hours) for patients with sepsis and septic shock was examined in a systematic review. In
severe sepsis or septic shock, the findings demonstrated no difference in mortality rates between patients
who received immediate antibiotic therapy compared to early antibiotic therapy. The overall quality of the
evidence was assessed as low and therefore caution should be exerted when interpreting the findings.1
(Level 3)
Patients suspected of sepsis who meet one or more high risk criteria are recommended to be
administered a broad-spectrum antimicrobial at the maximum dose recommended within the first hour of
being identified at high risk. People in the below group are at a higher risk of developing sepsis:2 (Level
3)
the very young (under one year) and older people (over 75 years) or people who are very frail
people who have impaired immune systems because of illness or drugs
people who have had surgery, or other invasive procedures, in the past six weeks
people with any breach of skin integrity (for example, cuts, burns, blisters or skin infections)
people who misuse drugs intravenously
people with indwelling lines or catheters.
A multi-national clinical guideline recommended that for adults with possible septic shock or a high
likelihood for sepsis, antimicrobials should be administered immediately, ideally within one hour of
recognition. This was based on very low to low quality evidence.3 (Level 5)
Characteristics Of The Evidence
This evidence summary is based on a structured search of the literature and selected evidence-based
health care databases. The evidence in this summary comes from:
A systematic review of 13 studies (prospective observational and retrospective cohort studies) including
33,863 participants.1
Evidence-based clinical practice guidelines.2,3
Best Practice Recommendations
1. Patients suspected of sepsis and assessed as at high risk of developing sepsis should receive a broad-
spectrum antimicrobial within the first hour of being identified at high risk. (Grade A)
References
1. Rothrock S, Cassidy D, Barneck M, Schinkel M, Guetschow B, Myburgh C, et al. Outcome of immediate versus early antibiotics in
severe sepsis and septic shock: a systematic review and meta-analysis. Ann Emerg Med. 2020; S0196-0644(20): 30337-1.
2. National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management: NICE guidelines 51. 2016.
www.nice.org.uk/guidance/qs51
3. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international
guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021; 47(11):1181-1247.
Archived Publications
1. JBI-ES-1480-1 (Published at 6 April 2021)
Author(s) potential or perceived conflicts of interest are collected and managed in line with the International Committee of Medical Journal Editors (ICMJE) standards.
How to cite: Porritt , K, Moola, S. Evidence Summary. Sepsis / Septic Shock: Immediate Versus Early Antibiotic Administration. The JBI EBP Database. 2022; JBIES-1480-2.
For details on the method for development see Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care information systems: A
streamlined rapid review approach. Worldviews Evid Based Nurs. 2015;12(3):131-8.
Note: The information contained in this Evidence Summary must only be used by people who have the appropriate expertise in the field to which the
information relates. The applicability of any information must be established before relying on it. While care has been taken to ensure that this Evidence
Summary summarizes available research and expert consensus, any loss, damage, cost or expense or liability suffered or incurred as a result of reliance on
this information (whether arising in contract, negligence, or otherwise) is, to the extent permitted by law, excluded.
Copyright © 2022 JBI licensed for use by the corporate member during the term of membership.
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