Antibiotic- and Fluid-Focused Bundles Potentially Improve Sepsis Management, but High-Quality Evidence Is Lacking for the Specificity Required in the Centers for Medicare and Medicaid Service's Sepsis Bundle (SEP-1)

Critical Care Medicine
Dominique J PepperPeter Q Eichacker

Abstract

To address three controversial components in the Centers for Medicare and Medicaid Service's sepsis bundle for performance measure (SEP-1): antibiotics within 3 hours, a 30 mL/kg fluid infusion for all hypotensive patients, and repeat lactate measurements within 6 hours if initially elevated. We hypothesized that antibiotic- and fluid-focused bundles like SEP-1 would probably show benefit, but evidence supporting specific antibiotic timing, fluid dosing, or serial lactate requirements would not be concordant. Therefore, we performed a meta-analysis of studies of sepsis bundles like SEP-1. PubMed, Embase, ClinicalTrials.gov through March 15, 2018. Studies comparing survival in septic adults receiving versus not receiving antibiotic- and fluid-focused bundles. Two investigators (D.J.P., P.Q.E.). Seventeen observational studies (11,303 controls and 4,977 bundle subjects) met inclusion criteria. Bundles were associated with increased odds ratios of survival (odds ratio [95% CI]) in 15 studies with substantial heterogeneity (I = 61%; p < 0.01). Survival benefits were consistent in the five largest (1,697-12,486 patients per study) (1.20 [1.11-1.30]; I = 0%) and six medium-sized studies (167-1,029) (2.03 [1.52-2.71]; I = 8%) but not ...Continue Reading

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Sep 17, 2019·Critical Care Medicine·Mitchell M Levy
May 7, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Chanu RheeMichael Klompas
Sep 15, 2020·Critical Care Medicine·Mitchell M Levy
Apr 26, 2020·Critical Care Medicine·Irene Cortés-PuchCharles Natanson
Nov 25, 2020·Surgical Infections·Christopher A GuidryRobert D Winfield
Feb 17, 2021·Critical Care Medicine·Sean C YuAndrew P Michelson
Jul 8, 2021·BMJ Quality & Safety·Alexis LopezNathan Houchens
Sep 21, 2021·Seminars in Respiratory and Critical Care Medicine·Jeremy WeinbergerChanu Rhee
Aug 4, 2021·Critical Care Medicine·R Phillip DellingerSean R Townsend

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