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Master Thesis

Évaluation de la mortalité à 30 jours après passage aux urgences adultes Lapeyronie du CHU de Montpellier pour sepsis ou choc septique : étude avant-après mise en place d’un outil d’aide à la prescription anti-infectieuse

Abstract : The anti-infectious strategy within a healthcare establishment is currently at the heart of public health issues. Severe septic states including sepsis and septic shock since 2016 are rapidly life-threatening with high mortality between 30 and 45% at one month. International and national recommendations concerning the comprehensive management of severe septic states and the need for early adapted probabilistic antibiotic therapy introduced within one hour of diagnosis have been issued since 2004 and updated regularly. Despite this, the antibiotic therapy for severe sepsis is still insufficiently adapted to the site of infection and to the patient, with an initiation period exceeding the "Golden Hour". Material and method: this retrospective before-after study carried out over a period of 13 months in the emergency medicine department of the CHU Montpellier took place in two phases. A first phase of six months called "before" of evaluation of professional practices with collection of data concerning each patient with severe sepsis, the antibiotic therapy introduced, the time to initiation and mortality at 30 days. The second six-month phase, called "after", took place 1 month after the implementation of an anti-infectious prescription aid tool depending on the site and the patient's comorbidities. The same data collection was carried out for each patient with severe sepsis. A comparison between the two phases with multivariate analysis is carried out in order to assess the 30-day mortality according to the patient's inclusion phase. Results: from July 12, 2020 to August 12, 2021, 371 patients were included in the study with 186 patients in the "before" phase and 185 patients in the "after" phase. Univariate analyzes comparing the patients included in each phase found two comparable populations with a significant difference in immunosuppression, predominantly in the "after" phase. A significant difference concerning the primary endpoint was demonstrated in multivariate analysis with lower 30-day mortality in the “after” phase (p=0.043). A significant difference was also found concerning the antibiotic therapy initiated with an improvement in the prescription in the “after” phase (p<0.001). On the other hand, no significant difference was found concerning the time taken to initiate the antibiotic therapy. (p=1). Conclusion: this before-after study showed an improvement in the 30-day mortality of patients with a severe sepsis state in the emergency medicine department of the CHU Montpellier after installation of the tool. Help with anti-infective prescription. The results showed an improvement in the antibiotic therapy initiated, better suited to the patient and his comorbidities. However, the time taken to initiate antibiotic therapy remains too long. The study is still ongoing with collection of data on mortality at 3 months. A second study, this time prospective, could be of interest to improve potency.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03455671
Contributor : Faculté de Médecine Um Connect in order to contact the contributor
Submitted on : Monday, November 29, 2021 - 5:59:48 PM
Last modification on : Saturday, December 18, 2021 - 3:26:03 AM

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Jordan Briquez. Évaluation de la mortalité à 30 jours après passage aux urgences adultes Lapeyronie du CHU de Montpellier pour sepsis ou choc septique : étude avant-après mise en place d’un outil d’aide à la prescription anti-infectieuse. Médecine humaine et pathologie. 2021. ⟨dumas-03455671⟩

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