Relying on electronic health record systems for integrated sepsis care protocols could have unintended consequences, including a rise in superbug infections, according to a new study.
Researchers at Mount Sinai Health System studied electronic sepsis screenings at a large, tertiary, urban academic medical center and found the system recommended treatments that could lead to the use of more broad-spectrum antibiotics. And that increases the risk of hospital-acquired Clostridium difficile infections, notes the study, which was published in the American Journal of Infection Control.
The study team examined more than 127,000 patient days from between June 2011 and July 2014. The EHR-based sepsis intervention recommends broad-spectrum antibiotics without preauthorization from a hospital's antibiotic stewardship experts.
C. diff infection rates were on the decline prior to the use of the sepsis protocols, but during their implementation the rates increased to 1.6 cases per 10,000 patient days. After the use of the electronic sepsis treatments, rates increased to 10.8 events per 10,000 patient days. In the three-year study window, researchers found a rate of 14.4 cases per 10,000 patient days.
The researchers said that the increased use of antibiotics may be linked to more sepsis cases, but it's more likely that the electronic interventions are identifying sepsis cases more quickly, leading to longer antibiotic treatments.
“Routine integrated sepsis treatment remains an integral part of how providers deliver rapid care to counter a sepsis diagnosis,” Linda Greene, R.N., president of the Association for Professionals in Infection Control and Epidemiology, said in an announcement. “But this is a double-edged sword: How do we prevent and treat sepsis while minimizing antibiotic resistance? We cannot diminish the importance of implementing swift treatment, but so, too, do we need more research to uncover solutions to the unintended consequences that ensue.”
A quick response to sepsis can be the difference between life and death for patients with such an infection. For every hour that clinicians fail to implement a common antisepsis protocol, hospital mortality rates increase by as much as 4%, research shows.
By the same token, reducing the use of antibiotics is the key solution to reducing the spread of antibiotic-resistant bacteria. The World Health Organization said last month that the number of antibiotics that can be used to treat these infections is lacking.