Introduction: Sepsis is defined by the 2021 Surviving Sepsis Campaign guidelines as a life-threatening organ dysfunction due to a dysregulated host response to infection. This condition can increase patient mortality, morbidity, length of inpatient stay, and overall healthcare costs. Prior literature demonstrated characteristics associated with increased inpatient length of stay (LOS) in those with sepsis; however, no relationship between uncontrolled hyperglycemia and longer hospital duration has been established. Therefore, this study was designed to assess the impact of blood glucose control during the first five days of hospitalization in septic patients. Methods: This retrospective, single-center, cohort study included participants who were admitted inpatient between July 1, 2020 and October 31, 2020 and had a documented diagnosis of diabetes and sepsis, identified by Medicare Severity-Diagnosis Related Group (MS-DRG) 871. Special populations were excluded. The primary outcome was hospital LOS. Secondary outcomes included all-cause inpatient mortality, hyper- and hypoglycemic events, 30-day hospital readmission, and ICU LOS. . Categorical data was analyzed using Chi-Square and Fischer’s Exact test, whereas continuous data was analyzed using Mann-Whitney U and Kruskal-Wallis test. An alpha of 0.05 was deemed statistically significant. Results: A total of 130 patients met inclusion criteria, with 64 patients in group A (≥ 80% of blood glucoses (BGs) below the goal value of 180 mg/dL) and 66 patients in group B (< 80% of BGs below goal). The majority of patients were male, caucasian, and had similar severity of illness defined by Charleston Comorbidity Index. The primary outcome, LOS, was statistically significantly different (7.01 days vs. 7.95 days; p = 0.039). Secondary outcomes were all-cause inpatient mortality (9.4% vs. 6.1%; p = 0.528), percentage of BG values within range (95% vs. 50%; p < 0.001), mean hypoglycemic events (0.23 vs. 0.69; p = 0.197), and median hyperglycemic events (1 vs. 8.5; p < 0.001). Additionally, a statistically significant difference was found when stratifying by three glycemic control groups for median LOS. Conclusions: Septic patients with more stringent glycemic control, defined as a blood glucose less than 180mg/dL, were associated with a decreased inpatient LOS.

The southern United States, including the Commonwealth of Kentucky has higher rates of antimicrobial use relative to the rest of the country. Antimicrobial stewardship experts discuss the state of antimicrobial use and explore stewardship issues and opportunities based on their practice experiences.

Critical Care Medicine: January 2022 - Volume 50 - Issue 1 - p 718 doi: 10.1097/01.ccm.0000812052.38715.1d