Delayed Second Dose Antibiotics for Patients Admitted From the Emergency Department With Sepsis: Prevalence, Risk Factors, and Outcomes*

Leisman, Daniel E.; Huang, Victor; Zhou, Qiuping; Gribben, Jeanie L.; Bianculli, Andrea R.; Bernshteyn, Michelle; Ward, M.F.; Schneider, Sandra

doi:10.1097/ccm.0000000000002377

Cited by 41 publications

(28 citation statements)

References 33 publications

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“…The importance of timing and appropriateness of the first dose of antibiotics has been shown in previous studies, especially in septic shock [9][10][11][12][13][14][15]33]. Leisman et al studied the importance of timely administration of the 2nd dose and showed that major delay in the 2nd dose was associated with higher mortality [17]. Therapeutic antibiotic concentrations in blood and at the target site must be achieved and maintained as quickly as possible in order to reduce bacterial load [20].…”

Section: Discussionmentioning

confidence: 99%

“…The timing of the 2nd dose of an appropriate antibiotic with renal elimination took into consideration the increased dose interval due to reduced renal excretion. When more than one adequate antibiotic was given, the longest recommended dose interval was applied [17]. The ratio for time interval between the first and second doses was calculated as the actual time divided by the recommended time interval.…”

Section: Definitions Of Appropriate and Early Antibiotic Treatmentmentioning

confidence: 99%

“…Time to first antibiotic has been well studied, but administration of subsequent doses has received less attention. However, Leisman et al [17] found that a major delay (> 25%) of the second dose was associated with increased Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-019-03529-8) contains supplementary material, which is available to authorized users. hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

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Delay of appropriate antibiotic treatment is associated with high mortality in patients with community-onset sepsis in a Swedish setting

Andersson

Balkhed

Fredrikson

et al. 2019

Eur J Clin Microbiol Infect Dis

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Early appropriate antimicrobial therapy is crucial in patients with sepsis and septic shock. Studies often focus on time to first dose of appropriate antibiotics, but subsequent dosing is equally important. Our aim was to investigate the impact of fulfillment of early treatment, with focus on appropriate administration of first and second doses of antibiotics, on 28-day mortality in patients with community-onset severe sepsis and septic shock. A retrospective study on adult patients admitted to the emergency department with community-onset sepsis and septic shock was conducted 2012-2013. The criterion Bearly appropriate antibiotic treatment^was defined as administration of the first dose of adequate antibiotics within 1 h, and the second dose given with less than 25% delay after the recommended dose interval. A high-risk patient was defined as a septic patient with either shock within 24 h after arrival or red triage level on admittance according to the Medical Emergency Triage and Treatment System Adult. Primary endpoint was 28-day mortality. Of 90 patients, less than one in four (20/87) received early appropriate antibiotic treatment, and only one in three (15/44) of the high-risk patients. The univariate analysis showed a more than threefold higher mortality among high-risk patients not receiving early appropriate antibiotic treatment. Multivariable analysis identified early non-appropriate antibiotic treatment as an independent predictor of mortality with an odds ratio for mortality of 10.4. Despite that the importance of early antibiotic treatment has been established for decades, adherence to this principle was very poor.

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Section: Discussionmentioning

confidence: 99%

Section: Definitions Of Appropriate and Early Antibiotic Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Delay of appropriate antibiotic treatment is associated with high mortality in patients with community-onset sepsis in a Swedish setting

Andersson

Balkhed

Fredrikson

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…The critical period between ED‐ and inpatient‐based care also provides opportunities for quality improvement, with a recent observational study finding delays to second doses of antibiotic in sepsis were common (delay of ≥25% dosing interval in one‐third of cases). This delay was associated with increased mortality, length of stay and requirement for mechanical ventilation . Routine prescription of weight‐based initial antibiotic doses for appropriate drugs as well as subsequent regular doses should be encouraged in the ED.…”

Section: Antimicrobialsmentioning

confidence: 99%

Review article: Sepsis in the emergency department – Part 3: Treatment

Williams

Keijzers

Macdonald

et al. 2018

Emerg Medicine Australasia

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Although comprehensive guidelines for treatment of sepsis exist, current research continues to refine and revise several aspects of management. Imperatives for rapid administration of broad-spectrum antibiotics for all patients with sepsis may not be supported by contemporary data. Many patients may be better served by a more judicious approach allowing consideration of investigation results and evidence-based guidelines. Conventional fluid therapy has been challenged with early evidence supporting balanced, restricted fluid and early vasopressor use. Albumin, vasopressin and hydrocortisone have each been shown to support blood pressure and reduce catecholamine requirements but without effect on mortality, and as such should be considered for ED patients with septic shock on a case-by-case basis. Measurement of quality care in sepsis should incorporate quality of blood cultures and guideline-appropriateness of antibiotics, as well as timeliness of therapy. Local audit is an essential and effective means to improve practice. Multicentre consolidation of data through agreed minimum sepsis data sets would provide baseline quality data, required for the design and evaluation of interventions.

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“…Недавнее исследование [75] показало, что среди па циентов с сепсисом, находящихся в отделении неотлож ной помощи, более чем у 50% пациентов имела место задержка введения первой и второй дозы антибиотика, равная примерно 4 ч. (для 6часовых интервалов до зирования).…”

Section: клинические рекомендацииunclassified

Review of the Guidelines of the Spanish Society of Chemotherapy on antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa

Дехнич¹,

Belotserkovskiy²,

Веселов³

et al. 2018

CMAC

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Ввиду исключительной способности P. aeruginosa формировать устойчивость практически ко всем доступным антибактериальным препаратам, выбор режима терапии инфекций, вызванных данным микроорганизмом, представляет собой трудную задачу. Поэтому, на наш взгляд, большой интерес представляют опубликованные в 2018 г. в журнале «Revista Española de Quimioterapia» рекоменда ции Испанского общества по химиотерапии по лечению острых инвазивных инфекций, вызванных Pseudomonas aeruginosa. В данном обзоре изложены основные положения вышеуказанных реко мендаций.

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Delayed Second Dose Antibiotics for Patients Admitted From the Emergency Department With Sepsis: Prevalence, Risk Factors, and Outcomes*

Cited by 41 publications

References 33 publications

Delay of appropriate antibiotic treatment is associated with high mortality in patients with community-onset sepsis in a Swedish setting

Delay of appropriate antibiotic treatment is associated with high mortality in patients with community-onset sepsis in a Swedish setting

Review article: Sepsis in the emergency department – Part 3: Treatment

Review of the Guidelines of the Spanish Society of Chemotherapy on antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa

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