Geographical Variations in Early Sepsis Bundle Compliance and Mortality in Hong Kong
Overview
This study analyzed 421,096 adult hospitalizations for community-acquired sepsis in Hong Kong from 2009 to 2018, revealing a low but increasing adherence to early sepsis management bundles. Full bundle adherence was associated with a 25% reduction in hospital mortality, with individual elements such as blood culture collection and appropriate broad-spectrum antibiotic use also linked to improved survival.
Background
Sepsis remains a significant global health challenge, with many countries adopting standardized management bundles to improve outcomes. However, real-world adherence to these bundles varies widely across regions and healthcare systems. Hong Kong, a high-income region without mandated sepsis bundle protocols, has limited data on longitudinal adherence and its impact on mortality. This study leverages a comprehensive electronic health record database to evaluate trends in sepsis bundle compliance and associated survival outcomes over a decade.
Adjusted odds ratio for mortality with full bundle adherence
0.75 (95% CI, 0.65–0.86)
Adjusted odds ratio for mortality with blood culture collection
0.88 (95% CI, 0.83–0.93)
Adjusted odds ratio for mortality with lactate measurement in septic shock
0.85 (95% CI, 0.76–0.94)
Adjusted odds ratio for mortality with appropriate broad-spectrum antibiotics
0.73 (95% CI, 0.56–0.96)
Key Findings
Full adherence to the early sepsis management bundle increased modestly from 0.2% in 2009 to 1.2% in 2018 in Hong Kong.
Empirical broad-spectrum antibiotic use increased at a faster rate (+9.8%/year) than antimicrobial resistance prevalence (+5.2%/year).
Full bundle adherence was associated with a 25% reduction in hospital mortality (adjusted OR 0.75).
Blood culture collection independently correlated with reduced mortality (adjusted OR 0.88).
Lactate measurement was linked to reduced mortality only in patients with septic shock (adjusted OR 0.85).
Appropriate use of broad-spectrum antibiotics improved survival in bacteremia caused by resistant pathogens (adjusted OR 0.73), highlighting the importance of targeted therapy.
Clinical Implications
Despite being a high-income region, Hong Kong demonstrates low adherence to sepsis bundles, underscoring challenges in implementing standardized sepsis care. Clinicians should prioritize not only increasing bundle compliance but also ensuring appropriate use of broad-spectrum antibiotics to optimize patient outcomes and mitigate risks associated with antimicrobial resistance. Regular auditing and guideline adoption may enhance adherence and survival.
Conclusion
This large population-based study highlights that full early sepsis bundle adherence is associated with improved survival in community-acquired sepsis, though overall compliance remains low. Efforts should focus on both increasing adherence and tailoring treatments appropriately to maximize benefits.
References
Lee et al. 2023 -- Geographical Variations in Compliance with Early Sepsis Management Protocols and Their Impact on Mortality Rates in Hong Kong from 2009 to 2018
by Jack Zhenhe Zhang, Chun Hei Chan, Lok Ching Chang, Lok Ching Sandra Chiu, Pauline Yeung Ng, Manimala Dharmangadan, Eunise Ho, Steven Ling, Man Yee Man, Ka Man Fong, Ting Liong, Alwin Wai Tak Yeung, Ka Fai Au, Jacky Ka Hing Chan, Michele Tang, Katy Hoi Ki Li, William Ka Kei Wu, Wai Tat Wong, Peng Wu, Benjamin J Cowling, Kwok Ming Ho, Anna Lee, Chanu Rhee, Lowell Ling
