scholarly journals Implementing a Collaborative Sepsis Protocol on the Time to Antibiotics in an Emergency Department of a Saudi Hospital: Quasi Randomized Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Rifat S. Rehmani ◽  
Javed I. Memon ◽  
Ayman Al-Gammal
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Randomized Study ◽  
Dose Delivery ◽  
Source Of Infection ◽  
Time To Antibiotics ◽  
The Impact ◽  
Mean Time ◽  
Antibiotic Dose

Background. The objective of this study is to evaluate the impact of an ED sepsis protocol on the time to antibiotics for emergency department (ED) patients with severe sepsis.Methods. Quasiexperimental prospective study was conducted at the emergency department. Consecutive patients with severe sepsis were included before and after the implementation of a sepsis protocol. The outcome measures were time from recognition of severe sepsis/septic shock to first antibiotic dose delivery and the appropriateness of initial choice of antibiotics based on the presumed source of infection.Results. There were 47 patients in preintervention group and 112 patients in postintervention group. Before implementation, mean time from severe sepsis recognition to delivery of antibiotics was 140 ± 97 minutes. During the intervention period, the mean time was 68 ± 67 minutes, with an overall reduction of 72 minutes. The protocol resulted in an overall improvement of 37% in the compliance, as 62% received appropriate initial antibiotics for the presumed source of infection as compared to 25% before the start of protocol.Conclusion. Implementation of ED sepsis protocol improved the time from recognition of severe sepsis/septic shock to first antibiotic dose delivery as well as the appropriateness of initial antibiotic therapy.

scholarly journals P003: Door-to-antibiotics and mortality for emergency department patients presenting with septic shock

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S64
Author(s):  
A. Aguanno ◽  
K. Van Aarsen ◽  
S. Pearce ◽  
T. Nguyen
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Linear Regression ◽  
Hospital Discharge ◽  
Statistical Significance ◽  
Serum Lactate ◽  
Secondary Outcome ◽  
Clinical Equipoise ◽  
Time To Antibiotics ◽  
The Impact

Introduction: We examined our local sepsis patient population, and specifically our most vulnerable patients - those presenting to the emergency department (ED) in septic shock - for variables predictive of survival to hospital discharge. We applied the familiar ED paradigm of, “Door to,” to calculate the impact of time to antibiotics against patient survival to hospital discharge. Methods: Retrospective chart review of patients aged > = 18 years, presenting to tertiary care ED between 01 Nov 2014 and 31 Oct 2015. Patients determined to have sepsis if A) > = 2 SIRS criteria and ED suspicion of infection (ED acquisition of blood/urine cultures or antibiotic administration) and/or B) received ED or Hospital discharge diagnosis of sepsis (ICD-10 diagnostic codes A4xx and R65). Patients sub-classified with septic shock if A) triage SBP < = 90mmHg, B) triage MAP < = 65mmHg or C) serum lactate > = 4mmol/L. “Door Time” was defined as the earliest time recorded for the patient encounter, either the time the patient registered in the Emergency Department, or the triage time. A generalized linear model was performed with a binomial distribution using survival to discharge as the response variable. Age, sex, ED arrival method, time to antibiotics, ED serum lactate and ED serum glucose level were the predictor variables. Results: 13506 patient encounters met inclusion criteria (10980 unique patients). Linear regression of time to antibiotics against survival to hospital discharge failed to achieve statistical significance. Linear regression of the secondary outcome variables achieved statistical significance for age and serum lactate level. Per the model, as age increased by 1 year, the odds of dying prior to hospital discharge increased by 3.8% and as serum lactate increased by 1 mmol/L, odds of dying prior to hospital discharge increased by 11.1%. Conclusion: We found no association between time to antibiotic treatment and mortality. Causal relationships require randomized controlled trials, and this analysis contributes to clinical equipoise.

Delays in Administration of the Second Antibiotic Dose in Patients With Severe Sepsis and Septic Shock

2019 ◽  
pp. 001857871988902
Author(s):  
Jana L. Randolph ◽  
Kin Chan ◽  
Amanda Albright ◽  
Aleda Chen
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Large Scale ◽  
Retrospective Chart Review ◽  
Single Center ◽  
Single Center Study ◽  
Sepsis And Septic Shock ◽  
The Impact ◽  
Antibiotic Dose ◽  
Dose Delay

Purpose: The aim of this study was to determine the incidence of significant delays in administration of the second antibiotic dose in patients treated for severe sepsis and septic shock at a single community teaching hospital as well as to assess patient outcomes associated with second dose delays. Methods: This single-center, retrospective chart review evaluated patients who received at least 2 antibiotic doses for severe sepsis or septic shock. Patients were classified as having experienced a significant second dose delay if the actual interval between the first and the second antibiotic doses was greater than or equal to 125% of the recommended dosing interval. Results: Of 197 patients, 38 (19.3%) experienced a significant second antibiotic dose delay. The rate of significant delays was 17.1% in patients treated initially in the emergency department and 30.3% in patients treated initially in another inpatient location. Conclusions: This single-center study found a 19.3% rate of significant delays in antibiotic second dose administration in patients with severe sepsis and septic shock. This study was not powered to identify differences in outcomes in patients with and without significant second dose delays. Additional large-scale studies are needed to investigate the impact of antibiotic second dose delays on outcomes in patients with sepsis.

scholarly journals Management and Outcome of Severe Sepsis and Septic Shock Patients

2018 ◽  
Vol 16 (2) ◽  
pp. 165-171
Author(s):  
Sabitri Lamichhane ◽  
Nayan Manandhar ◽  
Shailendra Dhakal ◽  
Yagya Laxmi Shakya
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Early Recognition ◽  
Management Strategies ◽  
University Teaching ◽  
Medical Attention ◽  
Apache Ii Score ◽  
Source Of Infection ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are major causes of morbidity and mortality worldwide and need immediate medical attention. Early recognition, fluid resuscitation and early antimicrobials are the mainstays of sepsis therapy. This study analyzed the management strategies of severe sepsis and septic shock and evaluated its impact.Methods: A prospective study was conducted on patients admitted through emergency department of Tribhuvan University Teaching Hospital of Nepal, who were diagnosed with severe sepsis and septic shock.Results: A total of 85 patients were diagnosed as severe sepsis and septic shock with 45 female patients and mean age 47.69 years ranging from 18 to 83 years. Pneumonia (45.9%) was found to be the major source of infection. The most commonly prescribed antibiotics and vassopressor at emergency department were ceftriaxone (24.7%) and norepinephrine (44.7%) respectively. The mean length of stay in Emergency department was 13.01 ± 7.03 h, while it was 11.27 ± 5.26 days in hospital. A total of 31 (36.5%) septic patients died. Deceased patients were found to have greater age, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score and presence of co-morbid conditions.Conclusions: This study looked in-depth on management and outcome of patients with severe sepsis and septic shock. Mortality from severe sepsis and septic shock were high, but similar to other studies.Keywords: Antimicrobial therapy; emergency department; mortality; septic shock; severe sepsis.

scholarly journals Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis

CJEM ◽  
2010 ◽  
Vol 12 (04) ◽  
pp. 303-310 ◽  
Author(s):  
Marc Francis ◽  
Tom Rich ◽  
Tyler Williamson ◽  
Daniel Peterson
Keyword(s):  
Emergency Department ◽  
Severe Sepsis ◽  
Median Time ◽  
Retrospective Chart Review ◽  
Emergency Department Patient ◽  
International Classification Of Diseases ◽  
Empiric Therapy ◽  
Source Of Infection ◽  
Before And After ◽  
Time To Antibiotics

ABSTRACTObjective:We sought to evaluate the time to antibiotics for emergency department (ED) patients meeting criteria for severe sepsis before and after the implementation of an ED sepsis protocol. Compliance with published guidelines for time to antibiotics and initial empiric therapy in sepsis was also assessed.Methods:A retrospective chart review was conducted. Emergency department patient encounters with International Classification of Diseases codes related to severe infections were screened during a 3-month period before and after the implementation of a sepsis protocol. Encounters meeting criteria for severe sepsis were further assessed. The time to initiation of antibiotics was determined as well as the initial choice of antimicrobial therapy based on the presumed source of infection.Results:We reviewed 213 unique ED patient encounters meeting criteria for severe sepsis. Analysis of the period before implementation showed a median time from the time criteria for severe sepsis were met to delivery of antibiotics of 163 minutes (95% confidence interval [CI] 124 to 210 min). Analysis of the period after implementation of the protocol revealed a median time of 79 minutes (95% CI 64 to 94 min), representing an overall reduction of 84 minutes (95% CI 42 to 126 min). Before the implementation of the protocol, 47% of patients received correct antibiotic coverage for the presumed source of infection in compliance with locally published guidelines. After the initiation of the protocol, 73% received appropriate initial antibiotics, for an overall improvement of 26%.Conclusion:A guideline-based ED sepsis protocol for the evaluation and treatment of the septic patient appears to improve the time to administration of antibiotics as well as the appropriateness of initial antibiotic therapy in patients with severe sepsis.

Impact of a Combination Antibiotic Bag on Compliance With Surviving Sepsis Campaign Goals in Emergency Department Patients With Severe Sepsis and Septic Shock

2017 ◽  
Vol 52 (3) ◽  
pp. 240-245 ◽  
Author(s):  
Michael P. Lorenzo ◽  
Lindsay MacConaghy ◽  
Christopher D. Miller ◽  
Gregory Meola ◽  
Luke A. Probst ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Primary Outcome ◽  
Intervention Group ◽  
Fluid Challenge ◽  
Surviving Sepsis Campaign ◽  
Goals Of Care ◽  
Sepsis And Septic Shock ◽  
The Impact

Background: Severe sepsis and septic shock represent common presentations in the emergency department (ED) and have high rates of mortality. Guideline-recommended goals of care have been shown to benefit these patients, but can be difficult to provide. Objective: To determine whether the use of a premixed bag consisting of 2 g cefepime and 1 g vancomycin in 1000 mL of normal saline increases the probability of patients receiving Surviving Sepsis Campaign (SSC) recommendations for the initiation of antimicrobials and fluid challenge. Methods: This was a 6-month retrospective analysis conducted to determine the impact of an intervention on time to antimicrobials and fluid administration in patients with severe sepsis and septic shock. Patients presenting to the ED who received a diagnosis of severe sepsis or septic shock and were administered 2 antibiotics were eligible for inclusion. The primary outcome assessed was compliance with SSC recommendations for antibiotic and fluid goals within 3 hours of ED arrival. Results: A total of 160 patients were included. In the intervention group, 63.8% of patients met the primary outcome compared with 22.5% in the historical group (odds ratio = 2.32; 95% CI = 1.67-3.23). Time to administration of antibiotics was less with the combination antibiotic bag (CAB: median (IQR) = 72 (48-115) minutes; non-CAB: median (IQR) = 135 (102-244) minutes; P ≤ 0.001). Conclusion: This intervention significantly increased the proportion of patients provided with SSC goals of care. Such interventions have not been reported previously and could be meaningful in the management of severe sepsis and septic shock.

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