Sepsis and Antimicrobial Resistance: Finding Balance

When weighing a prescribing decision, the realities of sepsis and concerns about antimicrobial resistance (AMR) can seemingly pull prescribers in opposite directions. However, sepsis and AMR should be considered together, as "two sides of the same coin," according to a viewpoint article recently published in BMJ Quality & Safety.¹

The authors explain that the way sepsis and AMR are framed in the media influences patient expectations and prescriber behavior. Sepsis is often framed as an immediate, concrete, and visible threat. On the other hand, AMR is framed as a vague, future threat. This causes patients and prescribers to be more concerned about the immediate threat of sepsis and discount the future threat of antimicrobial resistance.

Sepsis is Serious

Sepsis is indeed a real threat. It's one of the leading causes of patient deaths in hospitals. And shortening the time to targeted antimicrobial therapy is essential—survival declines by 7.6% for every hour of delay in initiation of effective antimicrobial therapy for patients in septic shock.² That urgency, combined with a physician's anxiety about missing a sepsis diagnosis may lead to "defensive prescribing," according to the authors.

In addition to concerns for the patient's welfare, physicians may be influenced by a hospital's adoption of "time-based targets for antimicrobial administration" in cases of sepsis. The article notes that, "Previous time-based US targets for pneumonia, which included financial compensation for timely administration of antimicrobials, had negative consequences for antimicrobial stewardship."

AMR Poses Real Risks

While sepsis is serious, AMR is also a real threat. Antibiotic-resistant bacteria and fungi cause 2.8 million infections each year in the US—and more than 35,000 people die from these infections, according to the CDC.³ This threat will continue to grow, impacting more people every year.

Going forward, the Viewpoint authors say sepsis and AMR concerns should be weighed together. "Achieving an appropriate balance requires reframing AMR as an immediate problem with consequences for individual practitioners and patients. Furthermore, inappropriate antimicrobial prescribing should be framed as a public health threat and a patient safety issue. This should include highlighting positive effects of more targeted prescribing, including the reduction of individual side effects such as hospital-acquired, multidrug-resistant infections."

Within healthcare organizations, sepsis and antimicrobial stewardship initiatives are often developed by different teams, "resulting in lack of alignment of goals and activities." Finding ways to foster alignment between sepsis and AMR programs would be a good starting place for creating a balanced approach.

Person in laboratory holds BIOFIRE pouch

The Role of Diagnostics

Fast, accurate diagnostics are a key component of addressing sepsis and AMR together. "In the future, new technologies enabling real-time, near-patient diagnosis of sepsis and identification of antimicrobial susceptibilities of the associated infection will be crucial to reducing uncertainty and the need for empirical prescribing decisions prone to bias," according to the article.

Prescribers and antimicrobial stewardship programs can already benefit from fast, comprehensive identification of bloodstream pathogens and associated antimicrobial resistance markers. The BIOFIRE^® Blood Culture Identification 2 (BCID2) Panel offers the ability to detect 33 pathogens (including gram-positive bacteria, gram-negative bacteria, and yeast) and 10 antimicrobial resistance markers—all with one test and results in about an hour after positive blood culture.

In fact, pairing the BIOFIRE^® FILMARRAY^® Blood Culture Identification (BCID) Panel with an antimicrobial stewardship program has been shown to provide the greatest benefit in terms of antimicrobial de-escalation.⁴

When it comes to sepsis, it's impossible to know what's causing the underlying infection without diagnostic testing. Traditional testing can be slow and insensitive, and sepsis patients typically receive empiric broad-spectrum antibiotics while awaiting results. Syndromic testing from BIOFIRE uses multiplex PCR technology to test for a broad menu of possible pathogens with one quick test, giving prescribers the information they need to make timely and targeted treatment decisions.

Learn more:

References

Fitzpatrick F, et al. BMJ Quality & Safety. 2019;28:758-761.
Kumar A, et al. Crit Care Med. 2006; 34(6):1589-96.
Antibiotic Resistance Threats in the United States, 2019. U.S. Department of Health and Human Services.
Banerjee R, et al. Clin Infect Dis. 2015;61:1071-80.