TY - JOUR
T1 - A modified Delphi approach to develop a trial protocol for antibiotic de-escalation in patients with suspected sepsis
AU - Yarrington, Michael E.
AU - Moehring, Rebekah W.
AU - David, Michael Z.
AU - Hamilton, Keith W.
AU - Klompas, Michael
AU - Rhee, Chanu
AU - Hsueh, Kevin
AU - Ashley, Elizabeth Dodds
AU - Sinkowitz-Cochran, Ronda L.
AU - Ryan, Matthew
AU - Anderson, Deverick J.
N1 - Publisher Copyright:
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
PY - 2021/11/8
Y1 - 2021/11/8
N2 - Background: Early administration of antibiotics in sepsis is associated with improved patient outcomes, but safe and generalizable approaches to de-escalate or discontinue antibiotics after suspected sepsis events are unknown. Methods: We used a modified Delphi approach to identify safety criteria for an opt-out protocol to guide de-escalation or discontinuation of antibiotic therapy after 72 hours in non-ICU patients with suspected sepsis. An expert panel with expertise in antimicrobial stewardship and hospital epidemiology rated 48 unique criteria across 3 electronic survey rating tools. Criteria were rated primarily based on their impact on patient safety and feasibility for extraction from electronic health record review. The 48 unique criteria were rated by anonymous electronic survey tools, and the results were fed back to the expert panel participants. Consensus was achieved to either retain or remove each criterion. Results: After 3 rounds, 22 unique criteria remained as part of the opt-out safety checklist. These criteria included high-risk comorbidities, signs of severe illness, lack of cultures during sepsis work-up or antibiotic use prior to blood cultures, or ongoing signs and symptoms of infection. Conclusions: The modified Delphi approach is a useful method to achieve expert-level consensus in the absence of evidence suifficient to provide validated guidance. The Delphi approach allowed for flexibility in development of an opt-out trial protocol for sepsis antibiotic de-escalation. The utility of this protocol should be evaluated in a randomized controlled trial.
AB - Background: Early administration of antibiotics in sepsis is associated with improved patient outcomes, but safe and generalizable approaches to de-escalate or discontinue antibiotics after suspected sepsis events are unknown. Methods: We used a modified Delphi approach to identify safety criteria for an opt-out protocol to guide de-escalation or discontinuation of antibiotic therapy after 72 hours in non-ICU patients with suspected sepsis. An expert panel with expertise in antimicrobial stewardship and hospital epidemiology rated 48 unique criteria across 3 electronic survey rating tools. Criteria were rated primarily based on their impact on patient safety and feasibility for extraction from electronic health record review. The 48 unique criteria were rated by anonymous electronic survey tools, and the results were fed back to the expert panel participants. Consensus was achieved to either retain or remove each criterion. Results: After 3 rounds, 22 unique criteria remained as part of the opt-out safety checklist. These criteria included high-risk comorbidities, signs of severe illness, lack of cultures during sepsis work-up or antibiotic use prior to blood cultures, or ongoing signs and symptoms of infection. Conclusions: The modified Delphi approach is a useful method to achieve expert-level consensus in the absence of evidence suifficient to provide validated guidance. The Delphi approach allowed for flexibility in development of an opt-out trial protocol for sepsis antibiotic de-escalation. The utility of this protocol should be evaluated in a randomized controlled trial.
KW - Sepsis
KW - antimicrobial stewardship
KW - modified Delphi
KW - patient safety
KW - protocol development
UR - http://www.scopus.com/inward/record.url?scp=85129812535&partnerID=8YFLogxK
U2 - 10.1017/ash.2021.205
DO - 10.1017/ash.2021.205
M3 - Article
C2 - 36168480
AN - SCOPUS:85129812535
SN - 2732-494X
VL - 1
JO - Antimicrobial Stewardship and Healthcare Epidemiology
JF - Antimicrobial Stewardship and Healthcare Epidemiology
IS - 1
M1 - e44
ER -