Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 9, 2025; 14(3): 101864
Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.101864
Correct sepsis classification–A must for antimicrobial stewardship: A longitudinal observational study
Jaideep Pilania, Prasan Kumar Panda, Udit Chauhan, Ravi Kant
Jaideep Pilania, Prasan Kumar Panda, Ravi Kant, Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India
Udit Chauhan, Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh 249203, Uttarākhand, India
Author contributions: Pilania J contributed to the data collection and data analysis, and was involved in manuscript writing; Panda PK provided the concept, interpreted the analysis, and critically reviewed the draft; Chauhan U and Kant R reviewed the draft. All authors have read and approved the final manuscript for publication.
Institutional review board statement: The study was reviewed and approved by Institutional Ethics Committee, AIIMS Rishikesh, ensuring patient confidentiality, data protection, and adherence to ethical standards in research involving human participants.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no conflicts of interest.
Data sharing statement: Data will be made available to others upon request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prasan Kumar Panda, MBBS, MD, Additional Professor, Department of Medicine, All India Institute of Medical Sciences, Room No. 409 College Block, Rishikesh 249203, India. motherprasanna@rediffmail.com
Received: September 28, 2024
Revised: March 2, 2025
Accepted: March 14, 2025
Published online: September 9, 2025
Processing time: 292 Days and 20.8 Hours
Abstract
BACKGROUND

Sepsis is a critical medical condition, and poses a substantial global health burden, with significant morbidity, mortality, and economic costs, particularly pronounced in low- and middle-income countries. Effective management of sepsis relies on early recognition and appropriate intervention, underscoring the importance of accurate classification to guide treatment decisions. The correct diagnosis will lead to effective antimicrobial stewardship practices.

AIM

To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.

METHODS

This longitudinal observational study in the Department of General Medicine, in a tertiary care hospital in Northern India, from 2023 to 2024, aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system. The study also aimed to correlate antibiotic usage. Patients were categorized into sepsis classes (Asepsis, Possible Sepsis, Probable Sepsis, Confirmed Sepsis) and followed until discharge or Day-28. Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.

RESULTS

A total of 1867 patients admitted with suspected sepsis were screened, with 230 meeting the inclusion criteria. Among the study cohort (mean age 40.70 ± 14.49 years, 50.9% female), initial sepsis classification predominantly included probable sepsis (51.3%) and possible sepsis (35.7%), evolving to asepsis (57.8%) upon final classification, but all received antibiotics. Empirical antibiotic use showed a predominance of Watch group antibiotics (72.2%), with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed; however, no statistical association could be established among the different classes of sepsis with the AWaRe groups.

CONCLUSION

Accurate sepsis classification is pivotal for clinical decision-making, optimizing antibiotic use, and combating antimicrobial resistance. The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization. The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation, potentially reducing unnecessary antibiotic exposure. Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.

Keywords: Antibiotic overuse; Antimicrobial resistance; AWaRe classification; Empirical therapy; New sepsis definition

Core Tip: Accurate sepsis classification is pivotal for clinical decision-making, optimizing antibiotic use, and combating antimicrobial resistance. The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization. The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation, potentially reducing unnecessary antibiotic exposure.