A study of nearly 100,000 adults treated for suspected infection suggests that the National Early Warning Score (NEWS2), a score based on routinely collected vital signs that is widely used to identify patients at risk of clinical deterioration, may help clinicians identify which patients are most likely to benefit from immediate antibiotic treatment and which may safely undergo further evaluation before receiving antibiotics.
NEWS2 has been adopted by many healthcare systems internationally and is recommended in the United Kingdom to help guide the urgency of antibiotic treatment in suspected sepsis, but until now there has been little empirical evidence supporting this approach.
The study, led by investigators from the Center for Sepsis Epidemiology & Prevention Studies (SEPSIS) at the Harvard Pilgrim Health Care Institute, appears in The Lancet Respiratory Medicine on August 5.
Refining urgent treatment decisions in sepsis
While timely administration of antibiotics is a cornerstone of sepsis care, diagnosing sepsis early can be complicated because its symptoms often overlap with many other serious medical conditions. Many patients treated for possible sepsis ultimately have non-infectious illnesses, exposing them to antibiotics that may offer limited benefit while increasing the risk of adverse effects and antibiotic overuse.
Recognizing the need to balance timely treatment with diagnostic uncertainty, international sepsis guidelines have evolved from recommending immediate antibiotics for all patients with suspected sepsis toward prioritizing patients with septic shock, where the evidence suggests treatment delays have the greatest impact on survival. However, it has remained unclear whether septic shock alone is sufficient to identify all patients who may benefit from immediate antibiotics.
“The challenge with sepsis is that clinicians must decide whether to give antibiotics right away before they know with certainty whether a patient has a serious bacterial infection,” says Chanu Rhee, Harvard Medical School associate professor at the Harvard Pilgrim Health Care Institute and lead author of the study. “Our study suggests that NEWS2, a simple early warning score based on routinely measured bedside parameters, can help identify the patients most likely to benefit from immediate treatment—including many beyond those with septic shock— while allowing clinicians greater confidence to take additional time evaluating lower-risk patients.”
Electronic health records
Researchers analyzed electronic health record (EHR) data from nearly 100,000 adults treated for suspected infection in emergency departments at nine U.S. hospitals between 2015 and 2024. They examined how the relationship between antibiotic timing and survival varied according to NEWS2 scores and the presence or absence of septic shock.
MICROBIOLOGY NEWS: Register with The Microbiologist for more free articles
To the researchers’ knowledge, this is the first large study to compare two international strategies for guiding the urgency of antibiotic treatment in suspected sepsis – the United Kingdom’s National Institute for Health and Care Excellence (NICE) recommendation to use NEWS2 to guide the urgency of antibiotic treatment in patients with suspected sepsis, alongside the Surviving Sepsis Campaign’s emphasis on septic shock.
Key findings
- Earlier Antibiotics Were Associated with Improved Survival in the Highest NEWS2 Category: Among patients with NEWS2 scores of 7 or higher, each additional hour to antibiotic treatment was associated with increased mortality.
- NEWS2 Identified Additional Patients Beyond Septic Shock: Many patients with NEWS2 scores of 7 or higher did not have septic shock but still showed an association between antibiotic delays and worse outcomes.
- No Survival Association at Lower NEWS2 Scores: Among patients with lower NEWS2 scores, earlier antibiotic treatment was not associated with improved survival.
- Potential to Better Guide the Urgency of Antibiotic Treatment: NEWS2 may offer a more comprehensive framework than septic shock alone for determining which patients warrant the most urgent antibiotic treatment.
Bedside score
“One of the most important unanswered questions in sepsis has been whether there is a better way to determine which patients are most likely to benefit from immediate antibiotics than relying on septic shock alone,” said Michael Klompas, Professor of Population Medicine at Harvard Medical School and senior author of the study.
“Our findings suggest that NEWS2 may provide an objective and practical way to identify those patients using a simple bedside score that is already routinely used in clinical practice.”
The researchers note that the study was observational and cannot prove that earlier antibiotic treatment directly caused differences in survival. Additional studies in other healthcare settings will be important to confirm the findings.
No comments yet