Searching the Surviving Sepsis Campaign database for avoidable deaths
Abstract number: R2521
Koeze J., Silderhuis V.M., Metz E., Halaby A., Kootstra G.J., Brouwer R.M.L.
Introduction: Recently it has been estimated that in the Netherlands yearly about 1700 deaths in hospitalised patients could be prevented by timely, accurate, diagnosis and adequate treatment. The surviving sepsis campaign is an international campaign aiming at a reduction in mortality with 25% in 5 years time. In March 2007 the SSC guidelines were introduced in the ICU, ER and the departments of Internal Medicine and Surgery of our hospital.
Aim of study: Analysis of cause of death in patients entered in the SSC database in terms of unnecessary and untimely deaths in order to detect possible flaws in the diagnostic and therapeutic process.
Methods: Retrospective analysis of prospectively obtained data from the SSC database a large non-academic teaching hospital.
Results: Ninety one patients (age 65±1.6 mean±s.e.m., 70% male) were included. 46 (50%) were admitted to the ICU, 45 patients (50%) were treated in the wards. Nineteen patients (20.7%) did not survive, 10 of these patients were not admitted to the ICU because of limits on escalation of treatment (LOT). Nine patients were admitted to the ICU. Six died in the ICU, cause of death multiorgan failure (n = 4) and withdrawal of futile treatment (n = 2). Three patients died after transfer from the ICU to the ward (all three with LOT).
In all patients blood cultures were taken, in 18 before intravenous empirical broad-spectrum antibiotics were started. Compliance to the resuscitation bundle was >80%. Blood cultures were positive in only two. Multiple sources of infection could be suspected in one patient. A pulmonary focus was suspected in 10 patients, however, in only one a suitable sputum specimen was obtained (Streptococcus pneumoniae, n = 1). Six patients were suspected to have a urinary tract infection, in five urinary cultures were taken (E. coli, n = 1; Klebsiella pneumoniae, n = 1). An abdominal focus was suspected in five patients, urine cultures were taken in four. In two patients the same microorganism was found in the blood and urinary culture (E. coli, Klebsiella pneumoniae). Microbiological data to narrow the antibiotic regimen were only available in a limited number of patients.
Conclusion: Compliance to the SSC bundles was excellent, but more microbiological samples of sputum should be obtained. Most patients who died in our SSC cohort had limits on escalation of treatment and cannot be counted as preventable deaths. Detailed analysis of cause of death improves the diagnostic and therapeutic process.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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