Trial reportIntensive care medicine2017
Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial.
Trial report in Intensive care medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01187134 (Medical Education for Sepsis Source Control and Antibiotics), which is not on this map. Cited by 93 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Medical Education for Sepsis Source Control and Antibiotics
Who cites it
93 citing papers in PubMed, 6 syntheses or guidelines pooled it, 197 citations in OpenAlex.
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Audit and feedback: effects on professional practice.The Cochrane database of systematic reviews · 2025Pooled it
- Timing of antibiotic initiation in sepsis and neutropenic fever.Frontiers in medicine · 2025Pooled it
- [Early source control of infection in patients seen in the emergency department: a systematic review].Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2024Pooled it
- Exploring the content and delivery of feedback facilitation co-interventions: a systematic review.Implementation science : IS · 2024Pooled it
- Continuing education meetings and workshops: effects on professional practice and healthcare outcomes.The Cochrane database of systematic reviews · 2021Pooled it
- Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature.Critical care (London, England) · 2021Trial
- Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia.Critical care (London, England) · 2018Trial
- The use of mid-regional proadrenomedullin to identify disease severity and treatment response to sepsis - a secondary analysis of a large randomised controlled trial.Critical care (London, England) · 2018Trial
- The German Quality Network Sepsis: study protocol for the evaluation of a quality collaborative on decreasing sepsis-related mortality in a quasi-experimental difference-in-differences design.Implementation science : IS · 2018Trial
- Admission lipid profile and outcomes in sepsis requiring early invasive source control.BMC infectious diseases · 2026Observational
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- [Sepsis care in Germany: quality indicators on diagnostics and treatment of sepsis].Die Anaesthesiologie · 2026Article
- Think sepsis, write sepsis, code sepsis - patient characteristics associated with sepsis (under-)coding in administrative health data.Infection · 2026Article
- The Role of Perceived Urgency and Barriers in Using Emergency Medical Care for Sepsis: A German-Wide, Representative Survey Using Case Vignettes.Critical care medicine · 2026Article
- Validation of CRownLab Pneumoplex for the Detection ofInternational journal of microbiology · 2026Article
- Personalized Approaches to Patients with Intra-Abdominal Infections.Journal of clinical medicine · 2025Review
- Source control in bloodstream infections in patients with sepsis, septic shock, or requiring ICU admission: a scoping review with recommendations for standardizing research.Intensive care medicine · 2025Article
- Empiric and targeted antibiotic therapy for bloodstream infections in internal medicine patients in Poland: a three-year analysis in a single centre using the AWaRe classification.Pharmacological reports : PR · 2025Article
- Effects of the Nudge Theory-Based Multifaceted Intervention on Reducing Inappropriate Proton Pump Inhibitors Use for Prophylaxis in Hospitalized Patients: A Non-Randomized Controlled Study.Journal of general internal medicine · 2025Article
33 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
29 authors at 14 institutions in 4 countries.
Funding
Abstract
purposeGuidelines recommend administering antibiotics within 1 h of sepsis recognition but this recommendation remains untested by randomized trials. This trial was set up to investigate whether survival is improved by reducing the time before initiation of antimicrobial therapy by means of a multifaceted intervention in compliance with guideline recommendations.
methodsThe MEDUSA study, a prospective multicenter cluster-randomized trial, was conducted from July 2011 to July 2013 in 40 German hospitals. Hospitals were randomly allocated to receive conventional continuous medical education (CME) measures (control group) or multifaceted interventions including local quality improvement teams, educational outreach, audit, feedback, and reminders. We included 4183 patients with severe sepsis or septic shock in an intention-to-treat analysis comparing the multifaceted intervention (n = 2596) with conventional CME (n = 1587). The primary outcome was 28-day mortality.
resultsThe 28-day mortality was 35.1% (883 of 2596 patients) in the intervention group and 26.7% (403 of 1587 patients; p = 0.01) in the control group. The intervention was not a risk factor for mortality, since this difference was present from the beginning of the study and remained unaffected by the intervention. Median time to antimicrobial therapy was 1.5 h (interquartile range 0.1-4.9 h) in the intervention group and 2.0 h (0.4-5.9 h; p = 0.41) in the control group. The risk of death increased by 2% per hour delay of antimicrobial therapy and 1% per hour delay of source control, independent of group assignment.
conclusionsDelay in antimicrobial therapy and source control was associated with increased mortality but the multifaceted approach was unable to change time to antimicrobial therapy in this setting and did not affect survival.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.