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A3304 - Frequency of Effective Early Antibiotic Administration in Culture Positive Sepsis
Author Block: A. Kaye1, S. J. Quinn2, V. Esmero3, G. D. Peksa4, C. R. Ayoub3, W. Kowacz3, J. Rey-Mendoza3, R. Gueret3, J. A. Greenberg2; 1Internal Medicine, Rush University Medical Center, Chicago, IL, United States, 2Pulmonary/Critical Care, Rush University Medical Center, Chicago, IL, United States, 3Pulmonary/Critical Care, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United States, 4Rush University Medical Center, Chicago, IL, United States.
RATIONALE: Mortality from sepsis incrementally increases with each hour delay in the administration of appropriate antibiotics. A central recommendation from the Surviving Sepsis Campaign is to administer early broad-spectrum antibiotics, defined as within 3 hours of ED triage. The purpose of this study was to determine the percentage of septic patients that received an early antibiotic, the percentage that received an early effective antibiotic, and whether the likelihood of receiving an effective antibiotic was associated with the ultimate culture results. METHODS: Adult admissions from the ED to the ICU at two academic hospitals in Chicago, Illinois from October 2012 to September 2014 were screened for sepsis using a validated ICD-9 search strategy. Charts were manually reviewed for inclusion if they met Sepsis-3 criteria and had positive blood cultures. We recorded time from ED triage to blood culture collection and antibiotic delivery. Organisms were grouped as resistant Gram-positive (i.e., methicillin-resistant Staphylococcus aureus [MRSA] or vancomycin-resistant Enterococcus species [VRE]), sensitive Gram-positive, resistant Gram-negative (i.e., resistant to cefepime, piperacillin-tazobactam, or carbapenems), or sensitive Gram-negative. RESULTS: Among a convenience sample of 203 patients with sepsis, 49 patients (24%) with positive blood cultures were identified. Of those 49 patients, 24 (49%) received early effective antibiotics, 7 (14%) received early ineffective antibiotics, and 18 (37%) did not receive any early antibiotics. Of the 24 patients who received early effective antibiotics, 2 (8%) grew MRSA, 10 (42%) grew sensitive Gram-positive organisms, and 12 (50%) grew sensitive Gram-negative organisms. Of the 25 patients who did not receive early effective antibiotics, 4 (16%) grew MRSA, 9 (36%) grew sensitive Gram-positive organisms, and 14 (56%) grew sensitive Gram-negative organisms. Two patients in this group grew multiple pathogens for a total of 27 identified organisms. No resistant Gram-negative organisms were identified in any group. There were no significant differences between the types of cultured pathogens among patients who received early effective antibiotics and among those who did not (p > 0.05). CONCLUSION: In sepsis patients with positive blood cultures, one half received early effective antibiotics, one third did not receive any early antibiotics, and one sixth received early ineffective antibiotics. Patients who received early effective antibiotics and those who did not were similar with respect to the pathogens that grew. These findings suggest that clinicians cannot predict the pathogen at the time of presentation or do not adjust the order of antibiotic administration to reflect their clinical suspicion.