Sepsis & Soft Tissue Infections

Strategic Leader: Robert Stenstrom

Vision

Optimal outcomes and efficiencies for emergency department patients with infections through research, advocacy, education, and knowledge translation.

Long Term Goal

To ensure that patients with infections in emergency departments across BC receive timely and optimal evidence-based care, and to establish our province as a leader in research and knowledge translation in this area.

Short Term Goals

  • To refine the criteria used to obtain blood cultures in emergency department patients with sepsis, and to identify “low-risk sepsis patients” in whom blood cultures are not necessary, thus saving the health care system money. .
  • To investigate the role of biomarkers in patients with sepsis and use these in a risk stratification score
  • To strengthen partnerships with the BC Patient Safety & Quality Council the Canadian Association of Emergency Physicians (CAEP) Critical Care Committee in the development of a cohesive strategy of evidence-based care for patients with sepsis and septic shock through knowledge generation, knowledge translation, and evaluation.
  • To build on existing relationships with the BC Ministry of Health Services/BC CDC and BC Centre for Excellence in HIV/AIDS to establish policy on point of care testing for HIV for all emergency department patients, and rapid linkage to care for patients found to be positive.
  • To develop a strategy for routine testing for hepatitis C in the emergency department.
  • To partner with industry and the BC Ministry of Health Services to develop a program of research on resistant bacteria (MRSA) and skin and soft tissue infections in the Emergency Department
  • To design research studies to identify high risk patients with infections and sepsis in the Emergency Department
  • To continue to enroll patients in an open label, industry- sponsored trial of a reversal agent for patients with life threatening bleeding on dabigatran (a newer non-vitamin K antagonist anticoagulant).

Key Partners & Stakeholders

  • DEM Provincial Members
  • Emergency Departments in B.C.
  • Practicing Health Professionals in Emergency Medicine
  • BCMA Section of Emergency Medicine
  • Ministry of Health
  • Health Authorities in British Columbia
  • Canadian Association of Emergency Physicians
  • BC CDC
  • BC Centre for Excellence in HIV/AIDS
  • B.C. Patient Safety and Quality Council
  • Center for Health Evaluation & Outcomes
  • Industry
  • University of British Columbia  Point of care HIV testingSepsis and septic shockBacterial resistance and skin and soft tissue infections (SSTIs)Treatment of life-threatening bleeding in patients on dabigatran with a reversal agent (iduracizimab)
  • We continue to enroll patients with serious bleeding in this important trial.
  • We currently have a number of studies ongoing in the area of resistant bacteria and SSTIs.  Such as: changing incidence and prevalence of MRSA in Vancouver; prevalence of MRSA across Canada; Randomized controlled trial of a novel antibiotic for the treatment of  MRSA SSTIs; Oral and IV antibiotic efficacy for SSTIs and risk factors for the acquisition of MRSA.
  • We have a growing database of emergency department patients with sepsis that we continue to mine for clues to identifying high risk patients and improving process outcomes (time to antibiotics, lactate measurements, etc). A study to assess the impact of rapid treatment of sepsis on various biochemical markers in septic patients is complete, with over 800 patients in our database. We are currently analyzing this data.
  • We completed a study of over 1,400 emergency department patients demonstrating the feasibility and benefits of point of care HIV testing. Widespread testing of all emergency department patients is now being conducted.

Work to Date

Point of care HIV testing

We completed a study of over 1,400 emergency department patients demonstrating the feasibility and benefits of point of care HIV testing. Widespread testing of all emergency department patients is now being conducted.

Sepsis and septic shock

We have a growing database of emergency department patients with sepsis that we continue to mine for clues to identifying high risk patients and improving process outcomes (time to antibiotics, lactate measurements, etc). A study to assess the impact of rapid treatment of sepsis on various biochemical markers in septic patients is complete, with over 800 patients in our database. We are currently analyzing this data.

Bacterial resistance and skin and soft tissue infections (SSTIs)

We currently have a number of studies ongoing in the area of resistant bacteria and SSTIs.  Such as: changing incidence and prevalence of MRSA in Vancouver; prevalence of MRSA across Canada; Randomized controlled trial of a novel antibiotic for the treatment of  MRSA SSTIs; Oral and IV antibiotic efficacy for SSTIs and risk factors for the acquisition of MRSA.

Treatment of life-threatening bleeding in patients on dabigatran with a reversal agent (iduracizimab)

We continue to enroll patients with serious bleeding in this important trial.