Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality in Patients With Sepsis

Kashiouris, Markos; Zemore, Zachary; Kimball, Zachary; Stephanou, Constantinos; Wit, Marjolein de; Fowler, Alpha A.; Fisher, Bernard; Sessler, Curtis N.

doi:10.1016/j.chest.2019.02.106

Cited by 2 publications

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…evaluated the impact of the time between prescription and antimicrobial administration on the mortality rate among a cohort of 4429 septic patients. The authors showed that the OR for 28 day mortality increased when antimicrobial therapy was administered beyond 1 h, reaching a median value of 1.85 (1.29–2.65) if the delay was more than 12 h [ 80 ]. Likewise, a retrospective analysis of 10,811 ED septic patients showed that each additional hour from ED arrival to antibiotic initiation increased the odds of 1 year [1.10 (1.05–1.14)], in-hospital [1.16 (1.07–1.26)], 30 day [1.12 (1.06–1.18)] and 90 day [1.09 (1.04–1.15)] mortality [ 81 ].…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Management of sepsis and septic shock in the emergency department

2021

View full text Add to dashboard Cite

Early management of sepsis and septic shock is crucial for patients’ prognosis. As the Emergency Department (ED) is the place where the first medical contact for septic patients is likely to occur, emergency physicians play an essential role in the early phases of patient management, which consists of accurate initial diagnosis, resuscitation, and early antibiotic treatment. Since the issuing of the Surviving Sepsis Campaign guidelines in 2016, several studies have been published on different aspects of sepsis management, adding a substantial amount of new information on the pathophysiology and treatment of sepsis and septic shock. In light of this emerging evidence, the present narrative review provides a comprehensive account of the recent advances in septic patient management in the ED.

show abstract

Section: Antimicrobial Therapymentioning

confidence: 99%

Management of sepsis and septic shock in the emergency department

2021

View full text Add to dashboard Cite

show abstract

Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality in Patients With Sepsis*

Kashiouris

Zemore

Kimball

et al. 2019

Critical Care Medicine

View full text Add to dashboard Cite

Objectives: There is mounting evidence that delays in appropriate antimicrobial administration are responsible for preventable deaths in patients with sepsis. Herein, we examine the association between potentially modifiable antimicrobial administration delays, measured by the time from the first order to the first administration (antimicrobial lead time), and death among people who present with new onset of sepsis. Design: Observational cohort and case-control study. Setting: The emergency department of an academic, tertiary referral center during a 3.5-year period. Patients: Adult patients with new onset of sepsis or septic shock. Interventions: None. Measurements and Main Results: We enrolled 4,429 consecutive patients who presented to the emergency department with a new diagnosis of sepsis. We defined 0–1 hour as the gold standard antimicrobial lead time for comparison. Fifty percent of patients had an antimicrobial lead time of more than 1.3 hours. For an antimicrobial lead time of 1–2 hours, the adjusted odds ratio of death at 28 days was 1.28 (95% CI, 1.07–1.54; p = 0.007); for an antimicrobial lead time of 2–3 hours was 1.07 (95% CI, 0.85–1.36; p = 0.6); for an antimicrobial lead time of 3–6 hours was 1.57 (95% CI, 1.26–1.95; p < 0.001); for an antimicrobial lead time of 6–12 hours was 1.36 (95% CI, 0.99–1.86; p = 0.06); and for an antimicrobial lead time of more than 12 hours was 1.85 (95% CI, 1.29–2.65; p = 0.001). Conclusions: Delays in the first antimicrobial execution, after the initial clinician assessment and first antimicrobial order, are frequent and detrimental. Biases inherent to the retrospective nature of the study apply. Known biologic mechanisms support these findings, which also demonstrate a dose-response effect. In contrast to the elusive nature of sepsis onset and sepsis onset recognition, antimicrobial lead time is an objective, measurable, and modifiable process.

show abstract

Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality in Patients With Sepsis

Cited by 2 publications

References 0 publications

Management of sepsis and septic shock in the emergency department

Management of sepsis and septic shock in the emergency department

Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality in Patients With Sepsis*

Contact Info

Product

Resources

About