Background: Sepsis is a common and life-threatening complication of infection that disproportionately affects patients with chronic comorbidities. Timely fluid resuscitation is a key initial management strategy for reducing sepsis mortality; however, patients with serious comorbidities are often excluded from clinical trials. The Surviving Sepsis guidelines suggest that patients meeting severe sepsis criteria should be administered [...]

Background: In 2016, the Sepsis-3 taskforce posited that acute organ failure is the defining feature of sepsis. Accordingly, they recommended that an acute rise in the Sequential Organ Failure Assessment (SOFA) score by 2 points over baseline should replace the Systemic Inflammatory Response Syndrome (SIRS) score as the sepsis criteria (1). As a justification, they [...]

Background: Sepsis, severe sepsis, and septic shock remain important contributors to hospital utilization, morbidity and mortality in the United States. Timely interventions including blood cultures, intravenous crystalloid infusions, and antibiotics make up the 3-hour sepsis bundle which represents current standard of practice, and the target of hospital quality reporting. Many aspects of sepsis care are [...]

Background: Prior exposure to antibiotics is associated with a subsequent risk for sepsis (Baggs et al., 2018). However, there are limited data on characteristics of patients readmitted with sepsis following previous antibiotic exposure during a non-sepsis related hospitalization. We sought to characterize factors associated with sepsis-related readmission (SRR) within 30 days of a non-sepsis index [...]

Background: Sepsis is associated with a six-fold greater risk of developing new-onset atrial fibrillation (AF). Patients with new onset AF demonstrate increased risk of stroke, vascular events, and death. However, the characteristics and management of new onset AF have not been well-described. Methods: We conducted a retrospective cohort study of patients aged ≥ 18 years [...]

Background: In the United States, 32 million people have a documented penicillin allergy and up to 20% of hospitalized patients’ records describe a penicillin allergy (PcnA). Less than 10% of patients with reported penicillin allergy have true clinically relevant PcnA when objectively tested through rigorous skin testing (1-3). Clinicians subsequently avoid appropriate penicillin or penicillin [...]

Background: The 2016 Surviving Sepsis Campaign guidelines recommend antibiotic administration within 1 hour of emergency department (ED) presentation for patients with sepsis. While early antibiotics are associated with reduced mortality, the 1 hr policy has been criticized for its one-size-fits-all approach and risk for over-diagnosis and treatment. Clinicians and quality leaders have called, instead, for [...]

Background: Sepsis is one of the most common causes for adult emergency department admissions and carries high morbidity and mortality. Appropriate and timely administration of intravenous (IV) antibiotics is one of the cornerstones of initial management of sepsis. Indeed, mortality has been shown to increase by 7-14% for each hour of delay in antibiotic administration. [...]

Background: Sepsis is a leading cause of hospital death and readmission (1-2). Prior work has suggested that early, adequate intravenous fluid (IVF) administration during sepsis care is associated with lower mortality, even among those at risk for fluid overload (including patients with chronic kidney disease [CKD] or heart failure [HF]) (3). At the same time, [...]

Background: Procalcitonin (PCT) testing has been shown in randomized trials to decrease antibiotic exposure and be a reliable predictor of clinical response to antibiotics in lower respiratory tract infection (LRTI) and sepsis. Although studied to guide antibiotic discontinuation in LRTI and sepsis, optimal strategies for introducing PCT into “real-world” clinical use are unknown. Our study [...]