IMPLEMENTING a structured sepsis protocol significantly improved the accuracy of empirical antibiotic selection for patients with carbapenem-resistant Gram-negative bacilli (CR-GNB) bacteremia. This is according to new research assessing the effect of institutional guidelines on clinical practice.
The study evaluated 612 patients treated for suspected sepsis before antibiotic susceptibility results were available. Researchers compared outcomes before and after the introduction of an institutional sepsis guideline designed around risk factors for multidrug resistance and local epidemiology. Infectious disease specialists were available around the clock, and broad-spectrum antibiotic use required specialist approval, ensuring high baseline stewardship.
Findings revealed a marked improvement in antibiotic precision following the guideline’s introduction. The rate of empirical antibacterial treatment tailored to multidrug resistance risk factors rose significantly [odds ratio (OR): 1.73; 95% confidence interval (CI): 1.21–2.48; p=0.003]. Moreover, appropriateness of initial antibacterial therapy based on subsequent antibiogram results increased more than threefold in the post-guideline period [OR: 3.25; 95% CI: 2.09–5.06; p<0.001]. Compliance with institutional recommendations improved steadily each year, alongside a rise in practices enhancing drug pharmacokinetics, such as using loading doses, prolonged meropenem infusions, and renal dose adjustments. These changes reflected broader adherence to stewardship-driven dosing optimization. The authors concluded that even in hospitals with continuous infectious disease support, formalized sepsis protocols can meaningfully enhance the appropriateness of empirical treatment for severe infections caused by drug-resistant Gram-negative bacteria. Strengthening local guidelines based on resistance patterns and pharmacologic principles may therefore be a critical step toward improving patient outcomes and combating antimicrobial resistance.
Reference: Uzar H et al. The impact of an institutional sepsis guideline on selecting appropriate empirical treatment in patients with carbapenem-resistant gram-negative bacilli bacteremia. Eur J Clin Microbiol Infect Dis. 2025; doi: 10.1007/s10096-025-05276-5
