The Infectious Diseases Society of America has released a position paper explaining why the organization decided not to endorse the 2016 Surviving Sepsis Campaign Guidelines, despite being part of the working group that developed the recommendations.
Members of the IDSA Sepsis Task Force stated in the paper that their perspectives and interpretations of major studies the guidelines are based on differed from those belonging to members of the Surviving Sepsis Campaign and Society of Critical Care Medicine (SCCM), who also took part in drafting the recommendations.
“IDSA admires the formidable work the Surviving Sepsis Campaign has done to improve care and outcomes for patients with sepsis and septic shock. The Surviving Sepsis Campaign has raised awareness about sepsis, emphasized the importance of early recognition, and focused attention on the need to treat septic patients aggressively and expeditiously with evidence-based interventions,” Henry Masur, MD, chief of the critical care medicine department at the NIH Clinical Center and professor of medicine at George Washington University, and colleagues wrote. “Nonetheless, IDSA did not agree with many important aspects of the Surviving Sepsis Campaign Guidelines.”
The IDSA’s major concern with the guidelines is that they fail to recognize the “practical difficulties” in diagnosing sepsis. The authors reported that up to 40% of patients admitted to ICUs for sepsis do not have an infection, and therefore, do not have sepsis.
“Hence, the benefits of treating patients who are infected need to be balanced against the harms of treating patients who at first appear as if they might have infections but in fact do not,” they wrote.
The guidelines strongly recommend initiating IV antimicrobials within 1 hour of identifying suspected sepsis or septic shock. Although it is “understandable and appropriate” to immediately administer broad-spectrum antibiotics and fluids to patients with suspected septic shock, the authors noted that health care providers should take the time to gather additional data and decide whether antibiotics are necessary in patients presenting with less severe disease who may not have an infection.
The IDSA Sepsis Task Force members also stated that the Surviving Sepsis Campaign Guidelines should:
- clearly distinguish combination therapy from multidrug therapy;
- recommend switching from combination therapy to monotherapy if test results confirm that the pathogens are susceptible to one active agent;
- provide more specific guidance on the use of biomarkers, specifically procalcitonin, and molecular tests to identify pathogens and guide treatment decisions;
- refer health care providers to existing guidelines dedicated to antibiotic prophylaxis use or provide a better understanding of infection prevention and prophylaxis; and
- recommend specific antibiotic treatment durations for certain conditions rather than establish a general duration of 7 to 10 days.
“We are disappointed that IDSA and SCCM were unable to resolve these issues before the Surviving Sepsis Campaign Guidelines were released,” Masur and colleagues concluded. “We hope we will be able to collaborate with SCCM and the Surviving Sepsis Campaign to find common ground for future guidelines. The IDSA strongly believes that patients and health care providers are best served if professional societies can speak with one voice on topics that are shared across specialties.” – by Stephanie Viguers
Disclosures: The authors report no relevant financial disclosures.