Rapid Responses to:

LETTERS:
Lindsay E M Reid
Surviving sepsis campaign's recommendations
BMJ 2007; 335: 1007 [Full text]
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[Read Rapid Response] When to intitiate the six hour sepsis bundle.
Kathryn M Howie, PaulJefferson and David R. Ball.   (21 November 2007)

When to intitiate the six hour sepsis bundle. 21 November 2007
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Kathryn M Howie,
Specialist Registrar
Dumfries and Galloway Royal Infirmary, UK, DG1 4AP,
PaulJefferson and David R. Ball.

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Re: When to intitiate the six hour sepsis bundle.

Reid emphasises the importance of early resuscitation in severe sepsis(1). She applies the six hour resuscitation bundle to the management of patients with the systemic inflammatory response syndrome (SIRS). This bundle, advocated by the “Surviving Sepsis Campaign Guidelines”(2) specifically refers to patients with severe sepsis or septic shock, not SIRS(2,3,4).

A prospective study looking at 3708 patients admitted to general medical and intensive care wards showed 68% developed SIRS. Only 18% of these developed severe sepsis and 4% septic shock(5). This seems to imply that if the guidelines from Reid(1) are followed, many more patients than are perhaps necessary will receive broad spectrum antibiotics. This could expose vulnerable patients to potential complications such as drug resistance.

1. Reid LEM. Surviving sepsis campaign’s recommendations. BMJ 2007:335;1007.

2. http://www.survivingsepsis.org/6hr_bundles (accessed 20 Nov 2007)

3. Rivers E, Bryant N, Havstad MA, et al. Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001:345;1368-77.

4. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004:32; 858-73.

5. Rangel-Frausto MS, Pittet D, Costigan M, Hwand T, Davis C, Wenzel RP. The natural history of the Systemic Inflammatory Response Syndrome (SIRS): a prospective study. JAMA 1995:273;117-23.

Competing interests: None declared