Balancing Early Antibiotic Administration and Stewardship in Sepsis

A session during the 46th Critical Care Congress addressed balancing early antibiotic administration and stewardship in sepsis.

At the start of the session Mitchell Levy, MD, MCCM, notes the importance of the topic. "Through the Surviving Sepsis Campaign ... we've produced sepsis performance metrics, which have now been adopted nationally by [the Centers for Medicare & Medicaid Services]. They mandate rapid institution of appropriate antibiotics for all patients suspected of sepsis within the first hour."

That's the good news. The bad news, according to Dr. Levy is that "we live in a time of serious concerns about antibiotics resistance." He noted many people say "the performance measures may have ... unintended deleterious consequences by driving antibiotics into patients that turn out later to not have infections. That's often been used as the reason to not to adhere to or accept the performance measures."
The Society of Critical Care Medicine has been working closely with the Centers for Disease Control and Prevention (CDC) in addition to the American College of Emergency Physicians the Infectious Diseases Society of America to address this issue.

"We've come to see how to balance this by marrying the rapid institution of appropriate antibiotics with antibiotic stewardship," Levy said. Panelists discuss the drive to make early antibiotics effective while minimizing how long patients receive antibiotics.

Panelists took questions from the audience and debated several questions, including whether the goals of integrating antibiotic stewardship with the rapid treatment of severe sepsis and septic shock were mutually exclusive. The group discussed practical and lesser known benefits of a robust antibiotic stewardship program, and how to balance rapid antibiotic choices while still protecting against antimicrobial resistance.

Panelists included Lauren Epstein, MD, from the CDC, Tiffany Osborn, MD, MPH, FCCM, FACEP, representing the American College of Emergency Physicians, and Stephen Weber, MD, representing the Infectious Dieseases Society of America. The session aimed to review coordination and staging of timely antibiotic administration and to recognize the impact that antibiotic resistance has in clinical medicine and sepsis. Dr. Epstein also served as a guest panelist during the Critical Connections Live broadcast on the New Guidelines for the Management of Sepsis and Septic Shock.

The Updated Surviving Sepsis Campaign guidelines (available in both Critical Care Medicine and Intensive Care Medicine) were released during the 46th Critical Care Congress, along with a viewpoint and synopsis published in JAMA. See the full list of resources at