Journal Article

Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan

Hifumi, Toru, Sakamoto, Yuichiro, Otomo, Yasuhiro, Okamoto, Kohji, Gando, Satoshi, Ueyama, Masashi, Shiino, Yasukazu, Kotani, Joji, Abe, Toshikazu, Sasaki, Junichi, Tarui, Takehiko, Masuno, Tomohiko, Yamashita, Norio, Ogura, Hiroshi, Nakada, Taka-aki, Ikeda, Hiroto, Shiraishi, Shin-ichiro, Fujishima, Seitato, Umemura, Yutaka, Saitoh, Daizoh, Shiraishi, Atsushi, Hagiwara, Akiyoshi, Takuma, Kiyotsugu, Tsuruta, Ryosuke, Mayumi, Toshihiko, Yamakawa, Kazuma, Takeyama, Naoshi, Kushimoto, Shigeki

2022

Overview

The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle; however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients. This was a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to intensive care units from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses. The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level, obtain blood cultures, administer broad-spectrum antibiotics, administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50%. In-hospital mortality was 18.0% in the patients with and 30.3% in the patients without bundle-adherent care (p = 0.054). The adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09-4.95) using propensity scoring. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour was related to in-hospital mortality (2.65 [95% CI 1.25-5.62] and 4.81 [95% CI 1.38-16.72], respectively). The adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04-1.57) by logistic regression analysis. Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Aged, 80 and over / Antibiotics / Biology and Life Sciences / Blood / Care and treatment / Critical care / Critical care medicine / Data collection / Emergency medical care / Evaluation / Female / Guideline Adherence / Health care / Health services / Hospital Mortality - trends / Hospitals / Humans / Infections / Intensive care / Intensive Care Units / Japan / Lactic acid / Logistic Models / Male / Management / Medicine / Medicine and Health Sciences / Methods / Mortality / Observational studies / Patient Care Bundles - methods / Patient compliance / Patient outcomes / Patients / Physical Sciences / Practice guidelines (Medicine) / Prospective Studies / R&D / Regression analysis / Research & development / Research and Analysis Methods / Sepsis / Sepsis - mortality / Sepsis - therapy / Tertiary / Tertiary Care Centers / Time Factors / University faculty / University graduates