Early antibiotics for blood poisoning could save thousands of lives doctor says

A Winnipeg doctor has a plan to save as many as 5000 Canadian lives for little cost Providing antibiotics to patients with severe sepsis a form of blood poisoning caused by infections soon after they roll through hospital doors Though it sounds simple enough some hospitals for both bureaucratic and philosophical reasons are not willing to jump on board so quickly

In Canada were still doing it on a piecemeal basis said Anand Kumar an intensivecare physician at Winnipeg Health Sciences Centre who along with his colleagues has been leading the charge for early antibiotics

Sepsis can occur when a bacterial fungal or viral infection moves into the bloodstream and attacks vital organs More than 9300 hospital patients died of sepsis in Canada in 2008 according to the latest data from the Canadian Institute for Health Information Put another way 30 per cent of patients in hospital with sepsis died compared with 18 per cent for strokes and 91 per cent for heart attacks

Dr Kumars research published in 2006 found that it generally took six hours to get antibiotics to sepsis patients for every hour delay the risk of dying went up by 75 per cent By getting antibiotics to patients within an hour or two after their blood pressure dropped six hospitals in Winnipeg have been able to reduce sepsisrelated mortality to 25 per cent from 65 per cent over the past few years translating to about 200 lives saved every year

We just didnt realize that the risk of death was so closely related to the simple parameter of how fast you give appropriate antibiotics said Dr Kumar And nobody seemed in a hurry to give them because were doing all these other things He and his team began a program to speed up antibiotics and if its applied across Canada Dr Kumar said it would cut the death rate from sepsis by half

While the program may seem intuitive not everyone is sold on the idea

Andrew Morris director of Torontos Mount Sinai Hospital and University Health Networks antimicrobial stewardship program fears that patients could be misdiagnosed in the rush to get them antibiotics or worse overprescribing drugs could lead to superbug infections such as C difficile Many times Dr Morris said it takes a while to get antibiotics to patients because its not immediately clear if they have an infection or there are other complications physicians have to contend with first

If everyone hears that the right thing to do is give everyone early antibiotics that may save a few lives but it also may cost a few lives Dr Morris said No one measures how many of those patients who didnt need antibiotics ended up getting C difficile and having problems like that down the road So there are consequences of that approach

Peter Brindley an intensivecare physician at the University of Alberta Hospital in Edmonton understands the cautious approach but believes Dr Kumars work has played a positive role in improving doortodrug times in his area Patients are getting a system jumping all over them And the antibiotics are probably the biggest part of it he said

There are no national guidelines around sepsis But Dr Kumar said the program has had a major impact in Winnipeg The cost to implement the program would be less than 20000 at each major hospital per year he said

Dr Kumar said hospital staff are used to a certain kind of thinking when a patient comes in with severe sepsis Stabilize the patient give them fluids get them on a ventilator and then when there was a bit of time give them antibiotics

Nobody really realized how important the antimicrobials are I think the new paradigm of thinking is that antibiotics are an intrinsic part of resuscitation That theyre no less important and maybe more important Dr Kumar said

Date : 28 May, 2012
Reference : www.theglobeandmail.com/news/national/early-antibiotics-for-blood-poisoning-could-save-thousa

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