{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:28:49Z","timestamp":1787020129140,"version":"build-2736575974"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis is a life-threatening condition responsible for millions of deaths worldwide. Although mortality rates have declined, sepsis remains a major global health concern. Early recognition and prompt, appropriate treatment are essential for improving patient outcomes. However, implementing effective sepsis management protocols in Emergency Departments (EDs) is often hindered by staff shortages and high patient volumes. Strengthening sepsis care is also crucial for promoting responsible antibiotic use. This study aimed to evaluate the impact of an antimicrobial stewardship (AMS) program\u2014based on stakeholder training, audit, and feedback\u2014implemented in the ED on the management of sepsis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective pre-post intervention analysis was conducted to assess changes in adherence to sepsis management guidelines and clinical outcomes following the introduction of the AMS program. The effect of the intervention on key process indicators was evaluated using Interrupted Time Series (ITS) analysis and logistic regression models adjusted for age and sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We analysed data from 577 septic patients in the pre-intervention period and 502 in the post-intervention period. Following implementation, sepsis recognition increased from 47.5% to 61% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Significant improvements were also observed in the collection of blood cultures (from 20.5% to 42.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), antibiotic administration (25.7% to 46.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), and crystalloid fluid administration (53% to 72%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Complete execution of the sepsis treatment bundle increased substantially post-intervention (OR 2.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Adherence to institutional antibiotic guidelines also improved (OR 4.54,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). ITS analysis confirmed improvements in all components of the sepsis bundle and in sepsis recognition after the intervention. Adherence to local antibiotic guidelines alone (OR 0.59, 95% CI 0.33\u20131.04) and in combination with sepsis recognition (OR 0.51, 95% CI 0.28\u20131.01) was associated with a reduction in 14-day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The AMS program led to substantial improvements in nearly all key process indicators for sepsis management, supporting the objectives of the WHO Global Action Plan on Antimicrobial Resistance, particularly in countries with high prevalence of multidrug-resistant bacteria (WHO. Global Action Plan on Antimicrobial Resistance; World Health Organization: Geneva, Switzerland; 2015). Process indicators were confirmed to be associated with improved short-term survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-11947-7","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T15:42:09Z","timestamp":1762962129000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Sepsis in the emergency department: a dual challenge of early management and antimicrobial stewardship"],"prefix":"10.1186","volume":"25","author":[{"given":"Romina","family":"Corsini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Marini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Ottone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo Giorgi","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana Maria","family":"Lattuada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Cocchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide Maria Francesco","family":"Lucchesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Cacciamani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Beneventi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuele","family":"Cantergiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Romani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Simion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Russello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Mezzadri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"issue":"8","key":"11947_CR1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","volume":"315","author":"M Singer","year":"2016","unstructured":"Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801\u201310. https:\/\/doi.org\/10.1001\/jama.2016.0287.","journal-title":"JAMA"},{"issue":"3","key":"11947_CR2","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1164\/rccm.201504-0781OC","volume":"193","author":"C Fleischmann","year":"2016","unstructured":"Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, Angus DC, Reinhart K. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. 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The Committee determined that informed consent from individual participants was not required, as the data were used for their primary purpose within a healthcare quality improvement and audit program. The secondary use of these data for research purposes was considered compliant with Article 110-bis of Legislative Decree 101\/2018, in accordance with the EU General Data Protection Regulation (Regulation EU 2016\/679). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1563"}}