Pilania Jaideep, Panda Prasan Kumar, Chauhan Udit, Kant Ravi
Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India.
World J Crit Care Med. 2025 Sep 9;14(3):101864. doi: 10.5492/wjccm.v14.i3.101864.
Sepsis is a critical medical condition, and poses a substantial global health burden, with significant morbidity, mortality, and economic costs, particularly pronounced in low- and middle-income countries. Effective management of sepsis relies on early recognition and appropriate intervention, underscoring the importance of accurate classification to guide treatment decisions. The correct diagnosis will lead to effective antimicrobial stewardship practices.
To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.
This longitudinal observational study in the Department of General Medicine, in a tertiary care hospital in Northern India, from 2023 to 2024, aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system. The study also aimed to correlate antibiotic usage. Patients were categorized into sepsis classes (Asepsis, Possible Sepsis, Probable Sepsis, Confirmed Sepsis) and followed until discharge or Day-28. Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.
A total of 1867 patients admitted with suspected sepsis were screened, with 230 meeting the inclusion criteria. Among the study cohort (mean age 40.70 ± 14.49 years, 50.9% female), initial sepsis classification predominantly included probable sepsis (51.3%) and possible sepsis (35.7%), evolving to asepsis (57.8%) upon final classification, but all received antibiotics. Empirical antibiotic use showed a predominance of Watch group antibiotics (72.2%), with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed; however, no statistical association could be established among the different classes of sepsis with the AWaRe groups.
Accurate sepsis classification is pivotal for clinical decision-making, optimizing antibiotic use, and combating antimicrobial resistance. The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization. The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation, potentially reducing unnecessary antibiotic exposure. Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.
脓毒症是一种严重的医学状况，给全球健康带来沉重负担，具有显著的发病率、死亡率和经济成本，在低收入和中等收入国家尤为突出。脓毒症的有效管理依赖于早期识别和适当干预，这凸显了准确分类以指导治疗决策的重要性。正确的诊断将有助于实施有效的抗菌药物管理措施。
评估印度北部一家三级医院中脓毒症类别分布以及世界卫生组织（WHO）的“准入、观察和储备”（AWaRe）系统所分类的经验性抗生素的使用情况，并将抗生素使用与脓毒症分类相关联。
这项于2023年至2024年在印度北部一家三级医院的普通内科进行的纵向观察性研究，旨在评估WHO的AWaRe系统所分类的经验性抗生素的使用情况。该研究还旨在关联抗生素使用情况。患者被分为脓毒症类别（无菌血症、可能脓毒症、很可能脓毒症、确诊脓毒症），并随访至出院或第28天。采用描述性和推断性统计分析来评估脓毒症类别和WHO的AWaRe系统所分类的经验性抗生素使用情况。
共筛查了1867例疑似脓毒症入院患者，其中230例符合纳入标准。在研究队列（平均年龄40.70±14.49岁，女性占50.9%）中，初始脓毒症分类主要包括很可能脓毒症（51.3%）和可能脓毒症（35.7%），最终分类时转变为无菌血症（57.8%），但所有患者均接受了抗生素治疗。经验性抗生素使用以观察组抗生素为主（72.2%），头孢曲松和哌拉西林 - 他唑巴坦是最常处方的药物；然而，不同脓毒症类别与AWaRe组之间未发现统计学关联。
准确的脓毒症分类对于临床决策、优化抗生素使用和对抗抗菌药物耐药性至关重要。大多数无菌血症类别在初次住院时被标记为很可能或可能脓毒症并给予了抗生素。经验性治疗中对观察组抗生素的高度依赖表明需要加强诊断策略以优化治疗起始，潜在地减少不必要的抗生素暴露。未来的努力应集中在如本研究中建立脓毒症分类检查表，并促进遵循抗菌药物管理原则，以减轻抗菌药物耐药性的全球威胁。
