Patient and Organizational Factors Associated With Delays in Antimicrobial Therapy for Septic Shock.


OBJECTIVES To identify clinical and organizational factors associated with delays in antimicrobial therapy for septic shock. DESIGN In a retrospective cohort of critically ill patients with septic shock. SETTING Twenty-four ICUs. PATIENTS A total of 6,720 patients with septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Higher Acute Physiology Score (+24 min per 5 Acute Physiology Score points; p < 0.0001); older age (+16 min per 10 yr; p < 0.0001); presence of comorbidities (+35 min; p < 0.0001); hospital length of stay before hypotension: less than 3 days (+50 min; p < 0.0001), between 3 and 7 days (+121 min; p < 0.0001), and longer than 7 days (+130 min; p < 0.0001); and a diagnosis of pneumonia (+45 min; p < 0.01) were associated with longer times to antimicrobial therapy. Two variables were associated with shorter times to antimicrobial therapy: community-acquired infections (-53 min; p < 0.001) and higher temperature (-15 min per 1°C; p < 0.0001). After adjusting for confounders, admissions to academic hospitals (+52 min; p< 0.05), and transfers from medical wards (medical vs surgical ward admission; +39 min; p < 0.05) had longer times to antimicrobial therapy. Admissions from the emergency department (emergency department vs surgical ward admission, -47 min; p< 0.001) had shorter times to antimicrobial therapy. CONCLUSIONS We identified clinical and organizational factors that can serve as evidence-based targets for future quality-improvement initiatives on antimicrobial timing. The observation that academic hospitals are more likely to delay antimicrobials should be further explored in future trials.


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@article{Amaral2016PatientAO, title={Patient and Organizational Factors Associated With Delays in Antimicrobial Therapy for Septic Shock.}, author={Andre Carlos Kajdacsy-Balla Amaral and Robert Andrew Fowler and Ruxandra L. Pinto and Gordon David Rubenfeld and Paul Ellis and Brian Bookatz and John C. Marshall and Greg Martinka and Sean P. Keenan and Denny P. Laporta and Daniel E Roberts and Anand Kumar}, journal={Critical care medicine}, year={2016}, volume={44 12}, pages={2145-2153} }