Lefrant et al. (2010) [37]

To determine whether the implementation of 10 recommendations adapted from the SSC guidelines results in a reduction of mortality inpatients with severe sepsis and septic shock.

Quasi-experimental study that had two consecutive phases: a 6-month quality control period (observational) and secondly a 6-month intervention period.

15 ICUs in southern France.

N = 538

Consecutive

2006

The 28-day mortality rate significantly decreased from 40% in the observational period to27% in the intervention period (p = 0.02).

Leisman et al. (2017) [38]

To determine mortality and costs associated with adherence to an aggressive, 3-hour sepsis bundle versus noncompliance

with greater than or equal to one bundle element for severe sepsis and septic shock patients.

Prospective, multisite, observational study used three sequential, independent cohorts, from a single USA health system, through their hospitalization.

Three cohorts in the USA: cohort 1: five tertiary and six community hospitals. Cohort

2: single tertiary academic medical center. Cohort 3: five tertiary

and four community hospitals.

N = 14,755 (n1 = 5819, n2 = 1697, n3 = 7239)

Consecutive

2010

In the three independent cohorts, 3-hour bundle compliance was associated with improved survival and cost savings. Mortality rate for compliant and non-compliant groups were: 21.3% and 25.4%, 13.4% and 17.8% and 18.1% and 21%, for cohorts 1, 2 and 3, respectively.

Memon et al. (2012) [39]

To assess the effect of improved compliance with the 6-hour sepsis resuscitation bundle on mortality of patients with severe sepsis and septic shock.

Quasi-experimental prospective design with a historical group as a control, and an intervention that was introduced over a 3-month period.

10-bedded

combined medical and surgical ICU in a governmental hospital in Saudi Arabia.

N = 299

Consecutive

2009-2011

The overall compliance with 6-hour sepsis resuscitation bundle elements was associated with improved survival[OR, 5.8 (95% CI, 2.2 - 15.1; p < 0.001)]. 30-day hospital mortality reduced from 31.3% in the historical group to 21.1% in the intervention group; p = 0.05. There was a significant 30-day hospital mortality reduction in the post-intervention group.