RIGHT SEPSIS CLASSIFICATION- MUST FOR ANTIMICROBIAL STEWARDSHIP: A LONGITUDINAL OBSERVATIONAL STUDY

Abstract

ABSTRACT Background: Sepsis is a critical medical condition characterized by life-threatening organ dysfunction triggered by a dysregulated response to infection. It poses a substantial global health burden, with significant morbidity, mortality, and economic costs, particularly pronounced in low- and middle-income countries. Effective management of sepsis relies on early recognition and appropriate intervention, underscoring the importance of accurate classification to guide treatment decisions. Objective: This longitudinal observational study aimed to assess the distribution of sepsis categories and the use of empirical antibiotics classified by the WHO AWaRe system in a tertiary care hospital in Northern India. The study also aimed to highlight implications for antimicrobial stewardship by examining the use of AWaRe group antibiotics and their correlation with sepsis classifications. Methods: A total of 1867 patients admitted with suspected sepsis were screened, with 230 meeting inclusion criteria. Patients were categorized into different sepsis classes (Asepsis, Possible Sepsis, Probable Sepsis, Confirm Sepsis) and followed until discharge or Day-28. Descriptive statistical analysis was employed to assess sepsis categories and empirical antibiotic usage classified by Access, Watch, and Reserve categories according to the WHO AWaRe system. Results: Among the study cohort (mean age 40.70 +/- 14.49 years, 50.9% female), initial sepsis classification predominantly included Probable Sepsis (51.3%) and Possible Sepsis (35.7%), evolving to Asepsis (57.8%) upon final classification. Empirical antibiotic use showed a concerning predominance of Watch group antibiotics (92.5%), with Ceftriaxone (45.7%) and piperacillin-tazobactam (31.7%) being the most commonly prescribed. Conclusion: The dynamic nature of sepsis classification underscores the complexity of diagnosing and managing this condition. Accurate categorization is pivotal for clinical decision-making, optimizing antibiotic use, and combating antimicrobial resistance. The majority of the asepsis category was levelled as probable or possible sepsis and given antibiotics. The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation, potentially reducing unnecessary antibiotic exposure. Future efforts should focus on establishing sepsis classification checklists and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.