Influence of an institution-specific sepsis protocol on the adequacy of empiric antimicrobial therapy

Objective: A sepsis protocol including institution-specific antibiotic recommendations based on local susceptibility patterns was implemented at our institution. The purpose of this investigation was to determine the impact of these recommendations on the adequacy of initial empiric therapy in patients with severe sepsis admitted to the intensive care unit.Methods: This was a single-center, retrospective, observational study conducted in a medical intensive care unit at a university-affiliated medical center. Charts of patients identified as having sepsis in our sepsis database from November 2004 to September 2006 were retrospectively reviewed. Adequacy of initial therapy was assessed, as were the number of antibiotics used per patient and 28-day mortality.Results: One hundred nine patients met inclusion criteria for the evaluation. Thirty-eight patients were in the pre-protocol group and 71 patients were in the post-protocol group. Adequacy of initial therapy increased from 68% pre protocol to 85% post protocol (P < 0.05). A secondary analysis showed that if antibiotic recommendations had been followed exactly according to protocol, the number of antibiotics per patient would decrease from 2.47 to 2.11 (P = 0.017) without changing adequacy of initial treatment.Conclusion: Implementation of a sepsis protocol containing institution-specific antibiotic recommendations was associated with an increased percent of patients receiving adequate empiric antibiotic therapy. Strictly adhering to the institution-specific antibiotic recommendations could result in fewer antibiotics used per patient without reducing the adequacy of empiric treatment.