The Impact of Timing of Antibiotics on Outcomes in Severe Sepsis and Septic Shock

Background: Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock. Methods: A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed. Patients were randomly selected from an internal intensive care unit (ICU) database at an academic medical center in the United States and screened for inclusion and exclusion criteria. Time-weighted phosphate was calculated using all phosphate measurements obtained during ICU admission. The associations between time-weighted phosphate and duration of mechanical ventilation, 28-day mortality, and ICU and hospital length of stay were evaluated using linear or logistic regression as appropriate. Results: One-hundred ninety-seven patients were evaluated: 33 were categorized as hypophosphatemia, 123 as normophosphatemia, and 41 as hyperphosphatemia. Patients with time-weighted hyperphosphatemia had a higher Simplified Acute Physiology Score III score and incidence of septic shock. Significantly higher rates of 28-day mortality were observed among those with time-weighted phosphate levels above 3.5 mg/dL. However, both time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. For every 0.5 mg/dL increase in time-weighted phosphate referent values from 4.0 to 6.0, the duration of mechanical ventilation decreased by 8% to 26%. For every 0.5 mg/dL decrease in time-weighted phosphate referent values from 3.0 to 1.0, significant decreases in duration of mechanical ventilation ranged from 14% to 41%. Conclusion: Time-weighted hyperphosphatemia may be associated with increased mortality in mechanically ventilated patients with severe sepsis or septic shock. However, time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. Future studies should further describe the impact of hypo- and hyperphosphatemia on clinical outcomes among critically ill patients with severe sepsis or septic shock.

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The impact of smoking on patient outcomes in severe sepsis and septic shock

Journal of Intensive Care ◽

10.1186/s40560-018-0312-x ◽

2018 ◽

Vol 6 (1) ◽

Cited By ~ 4

Author(s):

Fahad Alroumi ◽

Ahmed Abdul Azim ◽

Rachel Kergo ◽

Yuxiu Lei ◽

James Dargin

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Patient Outcomes ◽

Sepsis And Septic Shock ◽

The Impact

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Delays in Administration of the Second Antibiotic Dose in Patients With Severe Sepsis and Septic Shock

Hospital Pharmacy ◽

10.1177/0018578719889025 ◽

2019 ◽

pp. 001857871988902

Author(s):

Jana L. Randolph ◽

Kin Chan ◽

Amanda Albright ◽

Aleda Chen

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Large Scale ◽

Retrospective Chart Review ◽

Single Center ◽

Single Center Study ◽

Sepsis And Septic Shock ◽

The Impact ◽

Antibiotic Dose ◽

Dose Delay

Purpose: The aim of this study was to determine the incidence of significant delays in administration of the second antibiotic dose in patients treated for severe sepsis and septic shock at a single community teaching hospital as well as to assess patient outcomes associated with second dose delays. Methods: This single-center, retrospective chart review evaluated patients who received at least 2 antibiotic doses for severe sepsis or septic shock. Patients were classified as having experienced a significant second dose delay if the actual interval between the first and the second antibiotic doses was greater than or equal to 125% of the recommended dosing interval. Results: Of 197 patients, 38 (19.3%) experienced a significant second antibiotic dose delay. The rate of significant delays was 17.1% in patients treated initially in the emergency department and 30.3% in patients treated initially in another inpatient location. Conclusions: This single-center study found a 19.3% rate of significant delays in antibiotic second dose administration in patients with severe sepsis and septic shock. This study was not powered to identify differences in outcomes in patients with and without significant second dose delays. Additional large-scale studies are needed to investigate the impact of antibiotic second dose delays on outcomes in patients with sepsis.

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Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria

Intensive Care Medicine ◽

10.1007/s00134-012-2549-5 ◽

2012 ◽

Vol 38 (5) ◽

pp. 811-819 ◽

Cited By ~ 82

Author(s):

Peter M. C. Klein Klouwenberg ◽

David S. Y. Ong ◽

Marc J. M. Bonten ◽

Olaf L. Cremer

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Data Capture ◽

Definition Of ◽

Sepsis And Septic Shock ◽

The Impact ◽

Sirs Criteria

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Impact of a Combination Antibiotic Bag on Compliance With Surviving Sepsis Campaign Goals in Emergency Department Patients With Severe Sepsis and Septic Shock

Annals of Pharmacotherapy ◽

10.1177/1060028017739324 ◽

2017 ◽

Vol 52 (3) ◽

pp. 240-245 ◽

Cited By ~ 2

Author(s):

Michael P. Lorenzo ◽

Lindsay MacConaghy ◽

Christopher D. Miller ◽

Gregory Meola ◽

Luke A. Probst ◽

...

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Primary Outcome ◽

Intervention Group ◽

Fluid Challenge ◽

Surviving Sepsis Campaign ◽

Goals Of Care ◽

Sepsis And Septic Shock ◽

The Impact

Background: Severe sepsis and septic shock represent common presentations in the emergency department (ED) and have high rates of mortality. Guideline-recommended goals of care have been shown to benefit these patients, but can be difficult to provide. Objective: To determine whether the use of a premixed bag consisting of 2 g cefepime and 1 g vancomycin in 1000 mL of normal saline increases the probability of patients receiving Surviving Sepsis Campaign (SSC) recommendations for the initiation of antimicrobials and fluid challenge. Methods: This was a 6-month retrospective analysis conducted to determine the impact of an intervention on time to antimicrobials and fluid administration in patients with severe sepsis and septic shock. Patients presenting to the ED who received a diagnosis of severe sepsis or septic shock and were administered 2 antibiotics were eligible for inclusion. The primary outcome assessed was compliance with SSC recommendations for antibiotic and fluid goals within 3 hours of ED arrival. Results: A total of 160 patients were included. In the intervention group, 63.8% of patients met the primary outcome compared with 22.5% in the historical group (odds ratio = 2.32; 95% CI = 1.67-3.23). Time to administration of antibiotics was less with the combination antibiotic bag (CAB: median (IQR) = 72 (48-115) minutes; non-CAB: median (IQR) = 135 (102-244) minutes; P ≤ 0.001). Conclusion: This intervention significantly increased the proportion of patients provided with SSC goals of care. Such interventions have not been reported previously and could be meaningful in the management of severe sepsis and septic shock.

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Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: a descriptive analysis of a prospective observational study

Critical Care ◽

10.1186/s13054-019-2644-x ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 7

Author(s):

Toshikazu Abe ◽

◽

Shigeki Kushimoto ◽

Yasuharu Tokuda ◽

Gary S. Phillips ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Observational Study ◽

Hospital Mortality ◽

Prospective Observational Study ◽

Antibiotic Administration ◽

Coronary Syndrome ◽

Sepsis And Septic Shock ◽

The Impact ◽

Sepsis Care

Abstract Background Time to antibiotic administration is a key element in sepsis care; however, it is difficult to implement sepsis care bundles. Additionally, sepsis is different from other emergent conditions including acute coronary syndrome, stroke, or trauma. We aimed to describe the association between time to antibiotic administration and outcomes in patients with severe sepsis and septic shock in Japan. Methods This prospective observational study enrolled 1184 adult patients diagnosed with severe sepsis based on the Sepsis-2 criteria and admitted to 59 intensive care units (ICUs) in Japan between January 1, 2016, and March 31, 2017, as the sepsis cohort of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study. We compared the characteristics and in-hospital mortality of patients administered with antibiotics at varying durations after sepsis recognition, i.e., 0–60, 61–120, 121–180, 181–240, 241–360, and 361–1440 min, and estimated the impact of antibiotic timing on risk-adjusted in-hospital mortality using the generalized estimating equation model (GEE) with an exchangeable, within-group correlation matrix, with “hospital” as the grouping variable. Results Data from 1124 patients in 54 hospitals were used for analyses. Of these, 30.5% and 73.9% received antibiotics within 1 h and 3 h, respectively. Overall, the median time to antibiotic administration was 102 min [interquartile range (IQR), 55–189]. Compared with patients diagnosed in the emergency department [90 min (IQR, 48–164 min)], time to antibiotic administration was shortest in patients diagnosed in ICUs [60 min (39–180 min)] and longest in patients transferred from wards [120 min (62–226)]. Overall crude mortality was 23.4%, where patients in the 0–60 min group had the highest mortality (28.0%) and a risk-adjusted mortality rate [28.7% (95% CI 23.3–34.1%)], whereas those in the 61–120 min group had the lowest mortality (20.2%) and risk-adjusted mortality rates [21.6% (95% CI 16.5–26.6%)]. Differences in mortality were noted only between the 0–60 min and 61–120 min groups. Conclusions We could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis.

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