Sepsis Antibiotic Protocols: Potential Downstream Effects

Sir Alexander Fleming

"The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism."  Thus were the words of Sir. Alexander Fleming, the discoverer of penicillin.

We have a potential tragedy of the commons with antibiotics. The consequences extend beyond the growth of antibiotic resistance. The implementation of an electronic sepsis initiative to standardize and maximize antibiotic use for sepsis cases resulted in increased hospital onset C. difficile, as reported here in AJIC. Not surprisingly, the protocol resulted in increased broad spectrum antibiotic use.

Protocols and standardization generally improve patient safety (central line checklists, surgical times outs) but the process is not foolproof. 

We need to monitor and formally study unintended consequences so as to be nimble, pragmatic and modify our infection prevention strategies. 

I am now back from my native Argentina and back to the grind.