Sepsis Screening Possibly Linked to C. difficile Infection

Sepsis screenings and subsequent treatments could increase the risk for healthcare facility onset Clostridium difficile (C. difficile) infection, according to a new report.

Researchers from the Icahn School of Medicine at Mount Sinai used data collected from 4 medicine wards between June 2011—July 2014 in order to analyze the unintended consequences of sepsis screening and treatment protocols.

The study authors wrote that while sepsis treatments are designed to improve patient outcomes, sepsis remains a common cause of in-hospital morbidity and mortality. The Surviving Sepsis Campaign (SSC), launched to improve overall care of septic patients, suggests routine sepsis screening. However, healthcare facility onset C. difficile has increased in recent years with broad spectrum antibiotic use, allowing the researchers to explore a possible relationship between these 2 ideas. Sepsis is the leading cause of death in US hospitals, they said, with 1 diagnosis every 20 seconds.

The team implemented the Strengthening Treatment and Outcomes for Patients (STOP) Sepsis program in their hospitals in 2012, which uses an integrated tool in the electronic health records system and an electronic sepsis treatment bundle. The tool was designed to facilitate antibiotic administration to patients with suspected sepsis.

The researchers specifically looked at the sepsis screening programs, which utilized broad spectrum antibiotics, and healthcare facility onset C. difficile infection rates. Then, the team compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative.

Throughout the study period, there were 127,346 patient days in the 4 wards where the C. difficile infection rate was 14.4 per 10,000 patient days per month. The most commonly used broad spectrum antibiotics were cefepime and levofloxacin.

Study author Robert Hiensch, MD, told MD Magazine the researchers “were not entirely surprised to see antibiotic use increase, given the scope of the sepsis initiative and the emphasis on early and broad spectrum antibiotics.” However, he added, they were surprised to learn the antibiotic that increased the most was not part of the sepsis initiative order set — levofloxacin.

The study authors were not sure what to attribute this to, but they offered 3 potential explanations, Dr. Hiensch said: 1) sepsis order set usage rates are low at their institution, and others; 2) levofloxacin, while not usually used for sepsis treatment, may have been the antibiotic of choice as the patient stabilized and needed to be converted to oral or narrower coverage; and 3) the increase was due to factors unrelated to the sepsis initiative.

“In regards to our findings, we would not by any means discourage broad-spectrum antibiotic administration in the potentially septic patient,” Dr. Hiensch said to MD Magazine. "We would, however, like to draw attention to another sepsis guideline: the recommendation for daily assessment for de-escalation of antimicrobial therapy, given that unnecessarily prolonged administration of antimicrobials is detrimental to society and to the individual patients. This is especially true for the patients who may have ‘screened-in’ via the sepsis screening algorithm, but are deemed later, as further clinical data becomes available, to not have sepsis.”

The paper, titled “Impact of an electronic sepsis initiative on antibiotic use and health care facility—onset Clostridium difficile infection rates,” was published in the American Journal of Infection Control.