Sepsis represents a unique clinical dilemma with regard to antimicrobial stewardship. The standard approach to suspected sepsis in the emergency department centers on fluid resuscitation and timely broad-spectrum antimicrobials. The lack of gold standard diagnostics and evolving definitions for sepsis introduce a significant degree of diagnostic uncertainty that may raise the potential for inappropriate antimicrobial prescribing. Intervention bundles that combine traditional quality improvement strategies with emerging electronic health record–based clinical decision support tools and rapid molecular diagnostics represent the most promising approach to enhancing antimicrobial stewardship in the management of suspected sepsis in the emergency department.
Key points
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Antimicrobial stewardship refers to efforts aimed at enhancing judicious prescribing of these unique therapeutic agents in health care settings.
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Inappropriate use of antimicrobials represents a global threat to public health and a direct threat to individual patient safety.
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Sepsis is a life-threatening, complex clinical syndrome without a gold standard diagnostic test and thus represents a unique clinical dilemma with regard to antimicrobial stewardship.
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Recent literature questioning the clinical impact of time to antimicrobials in sepsis before the onset of shock and improving the definition of sepsis may have a positive impact on antimicrobial stewardship.
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Electronic health record clinical decision support, biomarkers, and rapid pathogen identification assays have tremendous potential to enhance antimicrobial stewardship in sepsis care and should be a focus of future research efforts.
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End Points of Sepsis Resuscitation
The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1
Appropriate Antibiotic Therapy
Sepsis Resuscitation in Resource-Limited Settings
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