Clinical Scorecard: Geographical Variations in Compliance with Early Sepsis Management Protocols and Their Impact on Mortality Rates in Hong Kong from 2009 to 2018
At a Glance
Category
Detail
Condition
Community-acquired sepsis (CAS) and septic shock
Key Mechanisms
Early sepsis management bundle adherence including empirical broad-spectrum antibiotic administration, blood culture collection, and lactate measurement
Target Population
Adult hospitalizations (≥18 years) for community-acquired sepsis in Hong Kong
Care Setting
Publicly funded hospitals in Hong Kong
Key Highlights
Full sepsis bundle adherence increased from 0.2% in 2009 to 1.2% in 2018 but remained low overall.
Full bundle adherence was associated with reduced hospital mortality (adjusted OR 0.75).
Empirical broad-spectrum antibiotics improved survival only when appropriately used for resistant pathogens.
Guideline-Based Recommendations
Diagnosis
Identify sepsis using clinical markers of infection and acute organ dysfunction (ΔSOFA ≥2) per Sepsis-3 criteria.
Define sepsis onset by first microbiological culture within first 3 days of hospitalization.
Management
Administer empirical broad-spectrum antibiotics early, prioritizing appropriate use based on pathogen resistance profiles.
Collect blood cultures promptly to guide targeted therapy.
Measure lactate levels, especially in patients with septic shock, to guide resuscitation.
Monitoring & Follow-up
Monitor adherence to sepsis management bundles including antibiotic administration, blood culture collection, and lactate measurement.
Track antimicrobial resistance prevalence to inform empirical antibiotic choices.
Risks
Overuse of broad-spectrum antibiotics may increase mortality and antimicrobial resistance.
Adults hospitalized with community-acquired sepsis in Hong Kong public hospitals
Empirical broad-spectrum antibiotic use increased faster than antimicrobial resistance prevalence; survival benefit observed only with appropriate antibiotic use targeting resistant pathogens.
Clinical Best Practices
Focus on improving full sepsis bundle adherence to enhance survival outcomes.
Prioritize appropriate empirical antibiotic selection based on local resistance patterns.
Ensure timely blood culture collection to guide antimicrobial therapy.
Use lactate measurement selectively in septic shock patients to reduce mortality.
Implement regular audits and guideline adoption in emergency departments to improve compliance.
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
