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Sepsis and antimicrobial stewardship: two sides of the same coin
  1. Fidelma Fitzpatrick1,2,
  2. Carolyn Tarrant3,
  3. Vida Hamilton4,
  4. Fiona M Kiernan5,
  5. David Jenkins6,
  6. Eva M Krockow7
  1. 1Clinical Microbiology, RCSI, Dublin, Ireland
  2. 2Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
  3. 3Department of Health Sciences, University of Leicester, Leicester, UK
  4. 4Department of Anaesthesia & Intensive Care, University College Hospital, Waterford, Waterford, Ireland
  5. 5Department of Anaesthesia and Intensive Care Medicine, RCSI, Dublin, Ireland
  6. 6Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
  7. 7Department of Health Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr Eva M Krockow, University of Leicester, Leicester LE1 7RH, UK; emk12{at}leicester.ac.uk

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Introduction

Sepsis and antimicrobial stewardship programmes coexist in tension, as they can appear to have apparently opposing messages around antimicrobial prescribing. In the era of increasing antimicrobial resistance (AMR), there is a need for greater alignment between sepsis and antimicrobial stewardship governance and management programmes. Antimicrobial therapy is an essential part of sepsis management with a focus on time-dependent recognition and resuscitation pathways.1 Sepsis is a clinical diagnosis, and delay to first-dose antimicrobial is associated with increasing mortality.1 To avoid potential unintended consequences from inappropriate antimicrobial prescribing, including increased AMR and healthcare-associated infections such as Clostridioides difficile infection, antimicrobial stewardship strategies including de-escalation protocols and stopping antimicrobials in non-infective cases should be a fundamental component of sepsis quality improvement initiatives.2 Perceived tensions remain, however, between managing sepsis and effective antimicrobial stewardship, and these perceptions are likely to be heightened by media reporting of the issues.3 The purpose of this viewpoint is to discuss these tensions, and suggest that a change in mindset is required with an integrated understanding of sepsis and AMR as two sides of the same coin.

Media framing of sepsis and AMR

Media framing of sepsis and AMR has been identified as influencing public expectation of antimicrobial prescribing as well as health professionals’ perceptions of optimal prescribing strategies. Sepsis media reports tend to use well-recognised triggers that increase public interest. These include emotive personal narratives that commonly centre on young patients, and which identify immediate solutions that are within the power of individual health professionals and the public (eg, increased awareness/recognition). In contrast, AMR is framed as a vague threat affecting future patients and involving multiple actors, often under the ‘One Health’ umbrella.4 Individual responsibility is diffused by presenting AMR as a global responsibility, which shares conceptual features with a ‘problem of many hands’,5 6 and the types …

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