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

Kashiouris, Markos; Zemore, Zachary; Kimball, Zachary; Stefanou, Christos; Fowler, Alpha A.; Fisher, Bernard; Wit, Marjolein de; Pedram, Sammy; Sessler, Curtis N.

doi:10.1097/ccm.0000000000003921

Cited by 21 publications

(13 citation statements)

References 36 publications

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“…Notably, fewer than 4% of included patients had septic shock [ 19 ]. Conversely, within a group of septic shock patients, data suggest a clear association between antibiotic administration delay and mortality [ 20 ]. Our study also shows an association between ED boarding time and prolonged ICU LOS.…”

Section: Discussionmentioning

confidence: 99%

Sepsis mortality and ICU length of stay after the implementation of an intensive care team in the emergency department

2023

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Emergency department patient boarding is associated with hospital mortality and increased hospital length of stay. The objective of the present study is to describe the impact of deploying an Intensive Care team in the ED and its association with sepsis mortality and ICU length of stay. Patients admitted to ICU through the ED with an ICD-10 CM diagnosis of sepsis were included. Preintervention and postintervention phases included 4 and 15 months, respectively. Sepsis time zero, SEP-1 compliance, and lag time from time zero to antibiotic administration were compared. Outcomes of interest were mortality and ICU LOS. 1021 septic patients were included. Sixty-six percent fulfilled compliance with 3 h SEP-1 bundle. Lag time from time zero to antibiotic administration was 75 min. Multivariate analysis showed no association between ICU team in the ED and hospital mortality (Log OR 0.94, CI 0.67–1.34; p = 0.73). The ICU team in the ED was associated with prolonged ICU LOS (Log OR 1.21, CI 1.13–1.30; p < 0.01). Septic shock and ED boarding time were associated with prolonged ICU LOS. Compliance with SEP-1 bundle was associated with its reduction. Implementation of an ICU team in the ED for the treatment of septic patients during high volume hospitalizations is not associated with a reduction of mortality or ICU LOS.

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Section: Discussionmentioning

confidence: 99%

Sepsis mortality and ICU length of stay after the implementation of an intensive care team in the emergency department

2023

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“…But etiology diagnosis is still slow despite of new multiplex PCR assays and mass spectrometry, leading to a delay in diagnosis [19]. Furthermore, these delays contribute to a greater risk of mortality [20,21]. Recent studies focus on the identifying of biomarkers that are helpful for the early diagnosis of sepsis, such as CRP and PCT [22].…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of miR-19b-3p in patients with sepsis and its regulatory role in the LPS-induced inflammatory response

Liu

2020

Eur J Med Res

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Background: MicroRNAs (miRNAs) play important roles in the development and progression of sepsis. This study investigated the clinical value of miR-19b-3p in sepsis patients, and explored its role in regulating inflammatory responses in HUVECs cells. Methods: 103 patients with sepsis and 98 healthy individuals were recruited. qRT-PCR was used for the measurement of miR-19b-3p level. Cell viability was evaluated using CCK-8. The protein levels of TNF-α and IL-6 were measured using ELISA. Receiver operating characteristic (ROC) curve and logistic regression analysis were constructed to evaluate the diagnostic and prognostic values of miR-19b-3p in sepsis patients. Results: MiR-19b-3p level was significantly reduced in the serum from patients with sepsis compared with healthy controls (P < 0.001). Sepsis patients in the survival group had significantly high miR-19b-3p levels compared with the non-survival group (P < 0.001). MiR-19b-3p was of a good value in predicting sepsis risk, and was an independent prognostic factor for 28-day survival in sepsis patients (OR = 3.226, 95% CI 1.076-9.670, P = 0.037). MiR-19b-3p level was negatively associated with serum levels of IL-6 (r = − 0.852, P < 0.001) and TNF-α (r = − 0.761, P < 0.001). Overexpression of miR-19b-3p alleviated LPS-induced inflammatory response of HUVECs, which was reflected by the decrease of the levels of IL-6 and TNF-α induced by LPS treatment (P < 0.001). Conclusion: MiR-19b-3p might be a potential biomarker for the early diagnosis and prognosis of sepsis patients. Overexpression of miR-19b-3p alleviated sepsis-induced inflammatory responses.

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“…Second, time from decision to administer antibiotics to time of actual administration of first dose antibiotics, which measures "administration delay" in the delivery of antibiotics (22). Both delays are associated with increased mortality (22)(23)(24). Studying these 2 key time points would allow targeted interventions to improve clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Delays in Time-To-Antibiotics for Young Febrile Infants With Serious Bacterial Infections: A Prospective Single-Center Study

et al. 2022

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IntroductionFear of missed serious bacterial infections (SBIs) results in many febrile young infants receiving antibiotics. We aimed to compare the time to antibiotics between infants with SBIs and those without.Materials and MethodsWe recruited febrile infants ≤ 90 days old seen in the emergency department (ED) between December 2017 and April 2021. SBI was defined as (1) urinary tract infection, (2) bacteremia or (3) bacterial meningitis. We compared the total time (median with interquartile range, IQR) from ED arrival to infusion of antibiotics, divided into (i) time from triage to decision for antibiotics and (ii) time from decision for antibiotics to administration of antibiotics.ResultsWe analyzed 81 and 266 infants with and without SBIs. Median age of those with and without SBIs were 44 (IQR 19–72) and 29 (IQR 7–56) days, respectively (p = 0.002). All infants with SBIs and 168/266 (63.2%) infants without SBIs received antibiotics. Among 249 infants who received antibiotics, the median total time from ED arrival to infusion of antibiotics was 277.0 (IQR 236.0–385.0) mins for infants with SBIs and 304.5 (IQR 238.5–404.0) mins for those without (p = 0.561). The median time to decision for antibiotics was 156.0 (IQR 115.0–255.0) mins and 144.0 (IQR 105.5–211.0) mins, respectively (p = 0.175). Following decision for antibiotics, infants with SBIs received antibiotics much faster compared to those without [107.0 (IQR 83.0–168.0) vs. 141.0 (94.0–209.5) mins, p = 0.017].ConclusionThere was no difference in total time taken to antibiotics between infants with SBIs and without SBIs. Both recognition and administration delays were observed. While all infants with SBIs were adequately treated, more than half of the infants without SBIs received unnecessary antibiotics. This highlights the challenge in managing young febrile infants at initial presentation, and demonstrates the need to examine various aspects of care to improve the overall timeliness to antibiotics.

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

Cited by 21 publications

References 36 publications

Sepsis mortality and ICU length of stay after the implementation of an intensive care team in the emergency department

Sepsis mortality and ICU length of stay after the implementation of an intensive care team in the emergency department

Clinical significance of miR-19b-3p in patients with sepsis and its regulatory role in the LPS-induced inflammatory response

Delays in Time-To-Antibiotics for Young Febrile Infants With Serious Bacterial Infections: A Prospective Single-Center Study

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