Infection increase an ‘unintended consequence’ of efforts to tackle sepsis say East Sussex hospital leaders

Clostridium difficile bacterium ENGPNL00120120625160132
Clostridium difficile bacterium ENGPNL00120120625160132

Efforts to reduce the number of patients who die from sepsis has led to a rise in cases of C. diff, hospital leaders have said.

At a meeting on Tuesday (April 2), members of the East Sussex Healthcare Trust (ESHT) board heard how the organisation had missed targets limiting the number of C. diff (clostridium difficile) infections in 2018/19.   

The board heard how the rise in the number of C. diff cases is thought to be an ‘unintended consequence’ of NHS efforts to prevent patients dying as a result of sepsis.

Vikki Carruth, the trust’s director of nursing, said: “Every year – as every trust is – we are assigned a limit for C. difficile cases. That limit was set at 40 and we ended the year, unfortunately, at 50 cases.

“Although it is a big number, there have been only two cases where we think there have potentially been lapses and they were back in July and August last year.

“I know from speaking to other trusts that they have breached their targets, so we don’t know whether we are going to start seeing this nationally as an unintended consequence of the work we are doing on sepsis.

“That is not to say it is okay, it isn’t. However with treatment of sepsis people start having to make decisions very quickly often without all of the normal resources we would wait to get.”

Mrs Carruth added the lapses were thought to be the result of broad-spectrum antibiotics treatments, which are antibiotics that work against several types of bacteria at the same time.

While considered an appropriate measure against sepsis, Mrs Carruth said it was possible these treatments could have been altered or stopped at an earlier point, potentially preventing the infection.  

A serious and potentially-deadly condition, sepsis occurs when something goes wrong with our bodies attempt to fight off bacterial infections, usually when someone has a weak immune system or an infection is particularly severe.

In these cases, the chemicals our bodies release to fight an infection trigger changes – such as inflammation – which causes more harm than the infection itself.

If this spreads too far, the condition can become septic shock which can result in death.

The condition is a particular risk for people already in hospital because of another serious illness.

Board members heard that broad-spectrum antibiotics are regularly used in the treatment of sepsis cases across the NHS, as it prevents the condition from worsening if caught early enough.

This speed of this treatment has increased in recent years as the NHS takes a more ‘aggressive approach’ to preventing sepsis deaths in hospitals, the trust board heard.

Unfortunately, hospital patients who have recently been treated with broad-spectrum antibiotics – or multiple different types of antibiotics – are at a higher-risk of contracting C. diff.

While relatively less serious than sepsis and fairly easily treated, C. diff is highly infectious and unpleasant, causing fever, stomach pains and diarrhoea.

ESHT medical director Dr David Walker said: “We have put a lot of effort into getting antibiotic treatment for patients arriving at the hospital with sepsis within the first hour.

“It has led to a 38 per cent reduction in mortality from sepsis in the trust.

“One of the problems of getting antibiotics within the first hour is you don’t always have a definitive diagnosis.

“You know the patient is unwell and you know they are septic but you don’t know what the bug is so you have to make a balanced decision about which antibiotic you choose.

“If you are not certain exactly where the infection is coming from, inevitably you have to choose a broader spectrum antibiotic than you would do if you knew exactly what the bug was.

“The downside of that is we then have a cohort of patients going through the trust who are on very broad spectrum antibiotics and we know that increases your risk of developing C. diff.”

Dr Walker said the only way of both reducing sepsis deaths and cases of C. diff, is to make sure a patient’s treatment is regularly reviewed and quickly altered once more information is available.

Work is underway to improve this process within the trust, Dr Walker said.