PLoS ONE (Jan 2022)

Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan

  • Yutaka Umemura,
  • Toshikazu Abe,
  • Hiroshi Ogura,
  • Seitato Fujishima,
  • Shigeki Kushimoto,
  • Atsushi Shiraishi,
  • Daizoh Saitoh,
  • Toshihiko Mayumi,
  • Yasuhiro Otomo,
  • Toru Hifumi,
  • Akiyoshi Hagiwara,
  • Kiyotsugu Takuma,
  • Kazuma Yamakawa,
  • Yasukazu Shiino,
  • Taka-aki Nakada,
  • Takehiko Tarui,
  • Kohji Okamoto,
  • Joji Kotani,
  • Yuichiro Sakamoto,
  • Junichi Sasaki,
  • Shin-ichiro Shiraishi,
  • Ryosuke Tsuruta,
  • Tomohiko Masuno,
  • Naoshi Takeyama,
  • Norio Yamashita,
  • Hiroto Ikeda,
  • Masashi Ueyama,
  • Satoshi Gando

Journal volume & issue
Vol. 17, no. 2

Abstract

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Background The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle; however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients. Methods This was a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to intensive care units from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses. Results The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level, obtain blood cultures, administer broad-spectrum antibiotics, administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50%. In-hospital mortality was 18.0% in the patients with and 30.3% in the patients without bundle-adherent care (p = 0.054). The adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09–4.95) using propensity scoring. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour was related to in-hospital mortality (2.65 [95% CI 1.25–5.62] and 4.81 [95% CI 1.38–16.72], respectively). The adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04–1.57) by logistic regression analysis. Conclusion Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality.