Antibiotic Timing and Outcomes in Sepsis

Kim, Richard; Ng, A.; Persaud, Annuradha; Furmanek, Stephen; Kothari, Yash; Price, John; Wiemken, Timothy; Saad, Mohamed; Guardiola, Juan; Cavallazzi, Rodrigo

doi:10.1016/j.amjms.2018.02.007

Cited by 42 publications

(27 citation statements)

References 31 publications

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“…These time-delays may be longer than previously noted in septic shock research in ED patients. 8,15 In our study this maybe partly due to 'time to antibiotic' being calculated as the time a patient receives the most appropriate antibiotic, which may not have been the first one administered. Most septic shock research has analysed the cohort as a whole group rather than stratifying into septic shock phenotypes.…”

Section: Discussionmentioning

confidence: 94%

“…Most septic shock research has analysed the cohort as a whole group rather than stratifying into septic shock phenotypes. Previous data in septic shock patients has demonstrated that for each hour increase in the time between triage and antibiotic administered there was a 16.9% increased risk of dying 15 highlighting the time from triage to sepsis recognition as critical. However, this has determined association rather than causation for these effects.…”

Section: Discussionmentioning

confidence: 96%

“…However, this has determined association rather than causation for these effects. 15 A significant proportion of our cohort was triaged to the acute section and was determined to have the LS (73.2%) phenotype. This group overall had significant delays to antibiotics.…”

Section: Discussionmentioning

confidence: 99%

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Examining the association between triage streamed treatment location and time to appropriate antibiotics in emergency department patients with septic shock

Ryan

Greenslade

Williams

2020

Emerg Medicine Australasia

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Objective: Early recognition and treatment for sepsis is critical in improving patient outcomes. The present study sought to examine whether triage location was associated with time to appropriate antibiotics in a cohort of ED patients with septic shock. Methods: Septic shock patients were identified from a database of ED patients admitted with infection. Demographic, clinical and outcome data were reported by triage location. Time to event analyses sought to identify the association between triage location and time to appropriate antibiotic. Secondary outcome variables included ED and hospital length of stay (LOS), 30-day mortality, and ICU admission. Results: Time to appropriate antibiotic administration was longer for those patients triaged to lower acuity (242 min) compared to higher acuity (98 min, P < 0.01) locations. After adjustment for severity of illness, hospital LOS, ED LOS and 30-day mortality were similar regardless of the triaged location. Admission to ICU was lower for patients triaged to lower (7.3%) compared to higher (47.3%) acuity treatment locations. Conclusions: We identified a subgroup of septic shock patients triaged to a lower acuity treatment location who received significant delays to antibiotics. This research area deserves closer examination to potentially recognise septic shock earlier in the continuum.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 96%

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Examining the association between triage streamed treatment location and time to appropriate antibiotics in emergency department patients with septic shock

Ryan

Greenslade

Williams

2020

Emerg Medicine Australasia

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“…Mortality from sepsis increases even when the delay before antimicrobial administration is very brief. 2 In this case, the medical team did not provide the patient with gram-negative coverage for six hours. Among patients presenting to the ED with pneumonia, urinary tract infections, bacteremia, and sepsis, patients with a history of penicillin allergy had a longer mean time to first antibiotic dose than patients without a history of penicillin allergy.…”

Section: Discussionmentioning

confidence: 97%

Delayed Sepsis Management Due to Ambiguous Allergy

2020

AORN Journal

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“…Indeed, these agents are responsible for 40-69% of sepsis-related deaths and critically ill children or those suffering from an underlying condition such as malignancy, or immunodeficiency, are at particular risk (2). Sepsis and septic shock are medical emergencies that warrant prompt resuscitation and antimicrobial therapy in order to improve prognosis (3)(4)(5). Choosing the antimicrobial agent adapted to the potential bacterial susceptibility is crucial.…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetic models of first choice beta-lactam antibiotics for severe infections treatment: What antibiotic regimen to prescribe in children?

Marsot

2020

J Pharm Pharm Sci

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Background: To perform a review describing the pharmacokinetic (PK) parameters and covariates of interest of the eight first choice β-lactams (BL) antibiotics for treatment of severe infections in pediatric population. Pediatric sepsis and septic shock reportedly affect 30% of children admitted to pediatric intensive care units, with a 25% mortality rate. Eight BL are included as first choice antibiotic for severe infections in pediatric population in the World Health Organization model list of essential medicines for children. Methods: The PubMed/Medline databases was searched and included studies if they described a population PK model of piperacillin, amoxicillin, ampicillin, cefotaxime, ceftriaxone, cloxacillin, imipenem or meropenem in neonates or children. We compared the PK parameters for each drug. We analysed the used covariates to estimate PK parameters. We compared the pharmacokinetics/pharmacodynamics (PK/PD) targets and the drug dosing recommendations. Results: Thirty-four studies met inclusion criteria with seven studies for piperacillin, five for amoxicillin, three for ampicillin, three for cefotaxime, two for ceftriaxone, two for imipenem and twelve for meropenem. None met inclusion criteria for cloxacillin. Ages ranged from 0-19.1 years with 12 studies including preterm. Body weight, age and renal function were the three major covariates in neonates and children. Different PK/PD targets were observed (between 40% to 100% of the dosing regimen interval of time over which the unbound (or free) drug concentration remains above the minimal inhibitory concentration (MIC) (fT>MIC) or four times the MIC (fT>4xMIC)). Several drug-dosing regimens were fond recommended according to the age and pathogens MIC using intermittent, timed or continuous infusions. Conclusions: Consensus is lacking on the optimal dosing regimens for these eight first choice antibiotics. A more personalized approach to antibiotic drugs dosing with individual characteristics of patient and pathogen susceptibility is required. According PK/PD targets and used dosing regimens, prospective clinical studies are required to investigate clinical cure, patient survival and emergence of antimicrobial resistance.

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Antibiotic Timing and Outcomes in Sepsis

Cited by 42 publications

References 31 publications

Examining the association between triage streamed treatment location and time to appropriate antibiotics in emergency department patients with septic shock

Examining the association between triage streamed treatment location and time to appropriate antibiotics in emergency department patients with septic shock

Delayed Sepsis Management Due to Ambiguous Allergy

Population pharmacokinetic models of first choice beta-lactam antibiotics for severe infections treatment: What antibiotic regimen to prescribe in children?

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