key: cord-0903030-zbr3m3zr
authors: Chotalia, Minesh; Ali, Muzzammil; Alderman, Joseph; Kalla, Manish; Parekh, Dhruv; Bangash, Mansoor; Patel, Jaimin
title: The authors reply
date: 2022-01-28
journal: Crit Care Med
DOI: 10.1097/ccm.0000000000005453
sha: 73b8e56f0d86a364f26d8fc74739d1b64272eb92
doc_id: 903030
cord_uid: zbr3m3zr

nan

T he recently published article by Lee et al (1) reported that preexisting clinical frailty was associated with worse outcomes in patients with sepsis. The authors demonstrated how frailty affected the outcome in patients with sepsis by carefully adjusting for background factors using propensity score matching. We would like to discuss how we should use their findings for sepsis in clinical practice.

Interestingly, they showed that inappropriate administration of antibiotics was more common in their frail group than in their nonfrail group. The latest Surviving Sepsis Campaign guidelines recommend empiric antimicrobials for coverage of methicillin-resistant Staphylococcus aureus or two antimicrobials for Gram-negative coverage, based on risk factors such as past bacteriological information and treatment history (2) . It is unclear whether the results by Lee et al (1) are due to repeated antibiotic exposures. However, because past medical information is often difficult to obtain accurately in emergency departments, frailty may be a new indicator for use of broad-spectrum antibiotics.

Their findings will also be useful in shared decision-making for patients with sepsis. However, we should interpret their finding carefully because some frail patients might have opted for limited treatment, such as via a do-not-intubate (DNI) order and limitations on treatment can affect outcome.

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