Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure
Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure
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DOI：
10.1093/cid/ciaa059
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发表时间：
2021-02-15
影响因子：
11.8
通讯作者：
Klompas, Michael
中科院分区：
文献类型：
--
作者：
Rhee, Chanu;Chiotos, Kathleen;Klompas, Michael
医疗保险和医疗补助服务中心的严重脓毒症和败血症休克早期管理捆绑(SEP-1)措施已适当地将脓毒症确立为国家优先事项。然而，美国传染病学会(IDSA和另外五个认可学会)担心SEP-1‘S可能导致抗生素过度使用，因为它没有考虑脓毒症过度诊断的高比率，并鼓励对所有可能发生脓毒症的患者使用积极的抗生素，而无论诊断的确定性或疾病的严重性。国际开发协会还感到关切的是，SEP-1的S复合体“时间为零”的定义缺乏证据，容易在观察者之间产生差异。在这份立场文件中，IDSA概述了几项建议，旨在降低SEP-1意外后果的风险，同时保持对其循证要素的关注。IDSA的核心建议是将SEP-1限制在感染性休克，对于这一点，支持立即使用抗生素益处的证据最多。快速经验性抗生素通常适用于疑似无休克的脓毒症，但IDSA认为，存在太多的异质性和定义这一人群的困难，对是否存在感染存在不确定性，以及关于立即使用抗生素的必要性的数据不足，以支持这一类别的所有患者的强制性治疗标准。IDSA认为，在没有休克的情况下处理可能的脓毒症的指南更适合于能够描述支持证据的强度和局限性的指南，并允许临床医生在对个别患者应用特定建议时酌情决定。在没有休克的情况下从SEP-1中清除脓毒症将减少对非感染综合征不必要的抗生素处方的风险，简化数据提取，增加测量的可靠性，并将注意力集中在最有可能从立即经验性广谱抗生素中受益的人群上。
The Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure has -appropriately established sepsis as a national priority. However, the Infectious Diseases Society of America (IDSA and five additional endorsing societies) is concerned about SEP-1's potential to drive antibiotic overuse because it does not account for the high rate of sepsis overdiagnosis and encourages aggressive antibiotics for all patients with possible sepsis, regardless of the certainty of diagnosis or severity of illness. IDSA is also concerned that SEP-1's complex "time zero" definition is not evidence-based and is prone to inter-observer variation. In this position paper, IDSA outlines several recommendations aimed at reducing the risk of unintended consequences of SEP-1 while maintaining focus on its evidence-based elements. IDSA's core recommendation is to limit SEP-1 to septic shock, for which the evidence supporting the benefit of immediate antibiotics is greatest. Prompt empiric antibiotics are often appropriate for suspected sepsis without shock, but IDSA believes there is too much heterogeneity and difficulty defining this population, uncertainty about the presence of infection, and insufficient data on the necessity of immediate antibiotics to support a mandatory treatment standard for all patients in this category. IDSA believes guidance on managing possible sepsis without shock is more appropriate for guidelines that can delineate the strengths and limitations of supporting evidence and allow clinicians discretion in applying specific recommendations to individual patients. Removing sepsis without shock from SEP-1 will mitigate the risk of unnecessary antibiotic prescribing for noninfectious syndromes, simplify data abstraction, increase measure reliability, and focus attention on the population most likely to benefit from immediate empiric broad-spectrum antibiotics.