Adalah Yahia, PharmD
PGY2 Critical Care Pharmacy Resident
Detroit Medical Center/Wayne State University
Detroit, MI
Disclosure information not submitted.
Yost Raymond, PharmD
Manager of Pharmacy Services
DMC Detroit Receiving Hospital, United States
Disclosure information not submitted.
Victoria Oyewole, PharmD
Clinical Pharmacist – Critical Care
University of California - Davis Medical Center, United States
Disclosure information not submitted.
Marco Scipione, PharmD, BCPS-AQ-ID
Clinical Pharmacist Specialist – Infectious Diseases
DMC Detroit Receiving Hospital, United States
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Rachel Wein, PharmD, BCPS
Clinical Pharmacist Specialist – Emergency Medicine
DMC Detroit Receiving Hospital, United States
Disclosure information not submitted.
Mark Pangrazzi, BCCCP, PharmD
Clinical Pharmacist Specialist – Critical Care
DMC Detroit Receiving Hospital, United States
Disclosure information not submitted.
Title: Time to Second Dose Antibiotics in Severe Sepsis and Septic Shock Patients Admitted from the ED
Introduction: Severe sepsis and septic shock are leading causes associated with hospital morbidity and mortality. Early appropriate antibiotic selections within the first 3 to 6 hours of admission are considered cornerstones to improve these outcomes. While emphasis is placed on time to first dose antibiotics, evidence-based outcomes for subsequent doses remain unclear. Barriers to timely antibiotic administration can contribute to suboptimal pharmacokinetic and pharmacodynamics parameters that result in sub-therapeutic concentrations. The purpose of this study was to evaluate the frequency of major delay in second dose antibiotic administration in severe sepsis and septic shock patients admitted from the emergency department and their potential negative outcomes.
Methods: This was a retrospective study of adult patients with severe sepsis and septic shock that received their first dose of antibiotics in the emergency department and were admitted between August 1, 2018 to August 1, 2020. Patients were excluded if they did not fulfill criteria for severe sepsis and septic shock within 24 hours of presentation, empiric antibiotic regimen was changed within the first 24 hours, had antibiotic discontinuation within 72 hours, or had active malignancy, neutropenic fever, or immunosuppression. The primary outcome was a major delay in time from first to second dose antibiotics (defined as ≥ 25% of the recommended time interval).
Results: A total of 13,026 patients with a sepsis alert were screened. Of these, 270 with severe sepsis and septic shock met the criteria. 32 (11.9%) had a delay ≥ 25% of the recommended time interval from first to second dose antibiotic. The incidence of delay increased with shorter dosing intervals. There was no observed difference in 28 day all-cause mortality, ICU length of stay, or hospital length of stay. Exploratory outcomes showed no statically significant difference in patient clinical outcomes in the first 48 hours after admission.
Conclusions: Delay in second dose antibiotics was not found to be common. Patients with shorter dosing intervals had an increased incidence of major delay. There was no observed association between major delay and patient clinical outcomes.