From the Guidelines
Outpatient management of sepsis without organ dysfunction after hospital discharge requires careful monitoring and completion of the full course of antibiotics prescribed at discharge, typically 7-14 days total, as recommended by the most recent guidelines 1.
Key Considerations
- Patients should be educated to monitor for signs of worsening infection, such as fever, increased heart rate, confusion, decreased urine output, or worsening symptoms, which warrant immediate medical attention.
- Follow-up with a primary care provider within 2-7 days of discharge is essential to assess clinical improvement and medication tolerance.
- Adequate hydration, rest, and nutritional support are crucial for promoting recovery.
- Laboratory tests, including complete blood count, C-reactive protein, and procalcitonin, may be ordered at follow-up visits to confirm resolution of the inflammatory response.
Antibiotic Regimens
- Common regimens include amoxicillin-clavulanate 875/125 mg twice daily, cefuroxime 500 mg twice daily, or levofloxacin 750 mg daily, adjusted based on culture results and antibiotic susceptibility.
- The choice of empiric antimicrobial regimen should be guided by factors such as the anatomic site of infection, prevalent pathogens, and resistance patterns, as outlined in the Surviving Sepsis Campaign guidelines 1.
Biomarkers and Diagnostic Tests
- Procalcitonin levels can be used to guide the initiation and discontinuation of antibiotics, as suggested by the European Society of Clinical Microbiology and Infectious Diseases guidelines 1.
- Blood cultures and other diagnostic tests should be used judiciously, based on the patient's clinical presentation and risk factors, to guide antibiotic therapy and reduce the risk of antibiotic resistance.
Overall Approach
- The goal of outpatient management is to ensure complete resolution of infection while allowing for early identification of complications or recurrence, reducing the risk of readmission and progression to severe sepsis.
- A structured approach to follow-up and monitoring, as recommended by the guidelines 1, can help achieve this goal and improve patient outcomes.
From the Research
Outpatient Care for Sepsis without Organ Dysfunction Post Hospital Discharge
- The management of sepsis, including cases without organ dysfunction, is crucial for reducing mortality and improving patient outcomes 2, 3.
- For patients with sepsis without organ dysfunction, the approach to care may differ from those with severe sepsis or septic shock, emphasizing the need for individualized treatment plans 3, 4.
- Studies have shown that sepsis survivors, including those without organ dysfunction, may have a significant risk of early readmission, highlighting the importance of post-discharge care and monitoring 4.
- Key factors that increase the risk of 7-day readmission in sepsis survivors include septic shock, multiple previous inpatient stays, prolonged index hospital length of stay, dyspnea, and functional dependencies 4.
- Antibiotic treatment in patients with sepsis, including those without organ dysfunction, should be approached with caution, considering the risk of multidrug-resistant pathogens and the need for individualized dosing 5.
- The use of broad-spectrum antimicrobials within the first hour of diagnosis is recommended, but de-escalation and shortened courses of antimicrobials should be considered for most patients, except in justified circumstances 5.
Considerations for Outpatient Care
- Patients with sepsis without organ dysfunction may not always meet diagnostic criteria within 3 hours of emergency department arrival, emphasizing the need for flexible and patient-centered care approaches 6.
- The development of sepsis care pathways and guidelines should consider the heterogeneity of sepsis presentations and the need for individualized treatment plans 3, 5.
- Antimicrobial stewardship and the optimization of antibiotic use are critical for improving patient outcomes and reducing the risk of antimicrobial resistance 2, 5.