Impact of an Antibiotic-specific Sepsis Bundle on Appropriate and Timely Antibiotic Administration for Severe Sepsis in the Emergency Department

• Published in: The Journal of emergency medicine 2016-01, Vol.50 (1), p.79-88.e1
• Main Authors: Kalich, Bethany A., PharmD, Maguire, Jennifer M., MD, Campbell-Bright, Stacy L., PharmD, Mehrotra, Abhi, MD, Caffey, Tom, MBA, Tulu, Zeynep, MS, Lin, Feng-Chang, PhD, Carson, Shannon S., MD
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; antibiotic; early goal-directed therapy; Emergency; Emergency Service, Hospital - statistics & numerical data; Female; Hospital Mortality; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; quality improvement; Quality Indicators, Health Care; Retrospective Studies; sepsis; Sepsis - diagnosis; Sepsis - drug therapy; sepsis bundle; Shock, Septic - drug therapy; Time Factors; timing
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2015.09.007

Abstract Background Guidelines recommend initiation of appropriate antimicrobial therapy within 1 h of severe sepsis diagnosis. Few sepsis bundles exist in the literature emphasizing initiation of specific antibiotic therapy. Objective To determine the impact of an antibiotic-specific sepsis bundle on the timely initiation of appropriate antibiotics. Methods For this before-and-after interventional study, the sepsis bundle at this 803-bed academic tertiary-care facility was redesigned to include specific antibiotic selection and dosing, based on suspected source of infection and susceptibility patterns. Protocol education and advertising was completed and bundle-specific antibiotics were put in the automated medication cabinet. Results Stepwise analysis of timely initiation of appropriate antibiotics included: 1) Was the initial antibiotic appropriate? 2) If so, was it initiated within 1 h of diagnosis? 3) If so, were all necessary appropriate antibiotics started? and 4) If so, were they started within 3 h of diagnosis? In comparing the 3-month-before group and 3-month-after group (n = 124), the appropriate initial antibiotic was started in 33.9% vs. 54.8% of patients (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.19–0.93, p = 0.03) and within 1 h in 22.6% vs. 14.5% of patients (OR 1.71, 95% CI 0.62–4.92, p = 0.36), respectively. All necessary appropriate antibiotics were initiated in 16.1% vs. 12.9% of patients (OR 1.30, 95% CI 0.42–4.10, p = 0.80), and within 3 h in 14.5% vs. 9.7% of patients, respectively (OR 1.58, 95% CI 0.46–5.78, p = 0.58). Conclusions An updated antibiotic-specific sepsis bundle, with antibiotics put in an automated medication cabinet, can result in improvements in the initiation of appropriate initial antibiotic therapy for severe sepsis in the emergency department.