TY - JOUR
T1 - The association of sepsis bundle compliance with mortality in patients with ICU-acquired sepsis
T2 - a cohort study
AU - Green, Adam
AU - Patel, Sharad
AU - Crabtree, Pamela
AU - Patel, Divyesha
AU - Hoke, Andrew
AU - Orozco, Ricardo Jaime
AU - Sangah, George
AU - Mercado, Alvin
AU - Melchiorre, Nicole
AU - Charron, Mariane
AU - Chandel, Abhimanyu
AU - Puri, Nitin
N1 - © 2025. The Author(s).
PY - 2025/5/20
Y1 - 2025/5/20
N2 - BACKGROUND: The efficacy of the SEP-1 Bundle has been questioned in the treatment of patients with hospital-acquired sepsis. We aimed to investigate bundle compliance and its association with survival in a subset of patients with HA sepsis: those with ICU-acquired sepsis.METHODS: A single-center retrospective cohort study was conducted in a tertiary care referral hospital. Adult patients diagnosed with ICU-acquired sepsis between 1 January 2019 and 31 December 2022 were identified. Survival to hospital discharge adjusted for disease severity based on 3-hour, 6-hour, and total bundle compliance was calculated. Secondary outcomes included the need for mechanical ventilation, vasopressors, initiation of acute hemodialysis, and discharge location.RESULTS: Of 191 patients with ICU-acquired sepsis, 61 patients (31.9%) demonstrated total bundle compliance. There was no difference in survival based on the unadjusted analysis of 3-hour bundle compliance, compliant versus non-compliant (78.9% vs. 67.0%; P = 0.100). However, there was a survival benefit in 6-hour and total bundle, compliance versus non-compliance (82.2% vs. 60.0%, P < 0.001; 86.9% vs. 64.6%, P = 0.002). When adjusted for SOFA and CCI, logistic regression demonstrated similar results: 3-hour compliance (OR: 0.60; 95% CI: 0.29-1.18, P = 0.150), 6-hour compliance (OR: 0.35; 95% CI: 0.17-0.68, P = 0.002) and total compliance (OR: 0.31; 95% CI: 0.13-0.69, P = 0.006). Components of the SEP-1 Bundle that showed a mortality benefit included the collection of "blood cultures prior to antibiotic administration" (OR: 0.46; 95% CI 0.22-0.96, P = 0.037) and "tissue perfusion assessment" (OR: 0.41; 95% CI 0.18-0.90, P = 0.028).CONCLUSIONS: Six-hour and total SEP-1 bundle compliance was associated with increased hospital survival in patients with ICU-acquired sepsis. These findings suggest the importance of sepsis bundle compliance in the ICU environment.CLINICAL TRIAL NUMBER: Not Applicable.
AB - BACKGROUND: The efficacy of the SEP-1 Bundle has been questioned in the treatment of patients with hospital-acquired sepsis. We aimed to investigate bundle compliance and its association with survival in a subset of patients with HA sepsis: those with ICU-acquired sepsis.METHODS: A single-center retrospective cohort study was conducted in a tertiary care referral hospital. Adult patients diagnosed with ICU-acquired sepsis between 1 January 2019 and 31 December 2022 were identified. Survival to hospital discharge adjusted for disease severity based on 3-hour, 6-hour, and total bundle compliance was calculated. Secondary outcomes included the need for mechanical ventilation, vasopressors, initiation of acute hemodialysis, and discharge location.RESULTS: Of 191 patients with ICU-acquired sepsis, 61 patients (31.9%) demonstrated total bundle compliance. There was no difference in survival based on the unadjusted analysis of 3-hour bundle compliance, compliant versus non-compliant (78.9% vs. 67.0%; P = 0.100). However, there was a survival benefit in 6-hour and total bundle, compliance versus non-compliance (82.2% vs. 60.0%, P < 0.001; 86.9% vs. 64.6%, P = 0.002). When adjusted for SOFA and CCI, logistic regression demonstrated similar results: 3-hour compliance (OR: 0.60; 95% CI: 0.29-1.18, P = 0.150), 6-hour compliance (OR: 0.35; 95% CI: 0.17-0.68, P = 0.002) and total compliance (OR: 0.31; 95% CI: 0.13-0.69, P = 0.006). Components of the SEP-1 Bundle that showed a mortality benefit included the collection of "blood cultures prior to antibiotic administration" (OR: 0.46; 95% CI 0.22-0.96, P = 0.037) and "tissue perfusion assessment" (OR: 0.41; 95% CI 0.18-0.90, P = 0.028).CONCLUSIONS: Six-hour and total SEP-1 bundle compliance was associated with increased hospital survival in patients with ICU-acquired sepsis. These findings suggest the importance of sepsis bundle compliance in the ICU environment.CLINICAL TRIAL NUMBER: Not Applicable.
KW - Adult
KW - Aged
KW - Cohort Studies
KW - Cross Infection/mortality
KW - Female
KW - Guideline Adherence/statistics & numerical data
KW - Hospital Mortality
KW - Humans
KW - Intensive Care Units/statistics & numerical data
KW - Male
KW - Middle Aged
KW - Patient Care Bundles
KW - Retrospective Studies
KW - Sepsis/mortality
UR - http://www.scopus.com/inward/record.url?scp=105005538890&partnerID=8YFLogxK
U2 - 10.1186/s12879-025-11134-8
DO - 10.1186/s12879-025-11134-8
M3 - Article
C2 - 40394519
AN - SCOPUS:105005538890
SN - 1471-2334
VL - 25
SP - 723
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 723
ER -