Stewardship and Sepsis: Are They Compatible?

Sepsis is a leading cause of death and disability globally. Sepsis affects millions of individuals per year and carries high morbidity and mortality rates even if appropriate care is provided. In the United States, sepsis is considered the most common cause of inpatient death, affecting 1.7 million adults per year and contributing to 270 000 deaths. Globally, there were an estimated 49 million cases of sepsis in 2017. The annual economic burden from sepsis hospitalizations and post-acute care exceeds $60 billion. Despite advances in care, short-term mortality rates continue to exceed 15%. Combining antimicrobial stewardship with diagnostic stewardship enhances sepsis management by improving recognition, treatment, and outcomes. Key factors include early detection of sepsis leading to optimal timing and initial choice of antimicrobials. Getting proper cultures and diagnostics improves de-escalation opportunities. Antimicrobial de-escalation reduces unnecessary broad-spectrum antimicrobials when the pathogen(s) and their susceptibilities are identified. Lastly, determining the optimal duration of antibiotic therapy based on diagnosis and clinical response. Over the past two decades, numerous randomized controlled trials (RCTs) have evaluated antibiotic durations for common clinical syndromes generally demonstrating that shorter courses are as effective as longer ones. Shorter treatment duration lowers risks of adverse drug reactions, multidrug resistance, and Clostridioides difficile infection. In conclusion, stewardship is not only compatible with sepsis care but also vital for better patient outcomes.