Department of Critical Care

Sepsis Management

Objective
The objective of this project is to determine the effect of antimicrobial stewardship (ASP), procalcitonin (PCT) testing, and rapid blood culture identification (BCID) on health outcomes, resource utilization and healthcare costs for children and adults with suspected or confirmed sepsis admitted to ICU.

Design and Setting
Multi-center, prospective, adaptive, time-series evaluation of ASP, PCT measurement and BCID testing in critically ill patients with confirmed or suspected sepsis admitted to the ICU from the emergency department (ED), the ward, operating theatre, or another ICU. The evaluation will be implemented at two Edmonton sites (University of Alberta Hospital and the Stollery Children's Hospital) and one Calgary adult site (Foothills Medical Center). After a 12-week baseline data collection period, there will be an adaptive 12-week evaluation of combined ASP, PCT and BCID implementation followed by an interim analysis to assess efficacy and effectiveness of the interventions and inform subsequent phases (i.e., continued evaluation of 3 interventions, evaluation of individual interventions, or project termination).

Interventions

Antimicrobial stewardship programs (ASP) are teams of pharmacists and infectious disease specialists who promote appropriate treatment of infections. Studies show that ASPs can improve patient survival, reduce side effects, reduce readmission rates, and even reduce antibiotic resistance.

Procalcitonin (PCT) is a substance produced by the body, often in response to a bacterial infection. The level of procalcitonin in the blood can increase significantly with bacterial infections including severe sepsis. Regularly measuring blood PCT levels can help guide doctors in the diagnosis and treatment of sepsis and guide the need for and duration of antibiotic therapy.  PCT Treatment Guidelines

BioFire FilmArray blood culture identification (BCID) is a test capable of accurately identifying approximately 85-90% of blood-stream bacteria which in turn helps physicians prescribe the most effective antibiotic therapy. BCID results are available to doctors in 1 to 1.5 hours which is about 48 hours earlier than traditional methods of identifying blood stream infections.

Population
All patients admitted to adult general systems ICUs at the University of Alberta Hospital (UAH) and Foothills Medical Center (FMC), as well as children admitted to the Stollery Pediatric ICU (PICU) with suspected or confirmed sepsis (Sepsis-3 definitions) will be eligible. Patients who die or are discharged within the first 24 hours of ICU admission will be excluded. Anticipated enrolment is estimated at 900 patients in 6 months.