title: Timing and appropriateness of initial antibiotic therapy in newly presenting septic patients.
abstract: OBJECTIVE
  To determine the effectiveness of antibiotic regimens and time to antibiotics in septic patients admitted to an intensive care unit from the emergency department.
  
  
  METHODS
  A retrospective case-control study of patients with sepsis syndromes admitted from the emergency department between August 2010 and July 2011 was conducted. Standard demographic information, time frames for written antibiotic orders and administration, and information regarding site of culture, organisms identified, sensitivities, and antibiotic effectiveness were documented.
  
  
  RESULTS
  Four hundred medical records were reviewed; 184 patients met the study inclusion criteria and were included in the final analysis. Simplified Acute Physiology Scores II and Sequential Organ Failure Assessment scores were 49 and 6, respectively, and overall in-hospital mortality was 20.7%. Patients with positive blood cultures had higher Simplified Acute Physiology Scores II scores (56.0 vs 46.0, P = .0125). Serum lactate levels were also significantly higher in the in-hospital mortality group (3.2 vs 2.1, P = .0068). Computerized physician order entry dramatically decreased the median times to the last appropriate antibiotic administration (3.183 hours vs 6.992 hours, P < .0001) but did not alter mortality (20.6% vs 20.8%). Appropriateness of empiric antibiotic regimens was similar between patients surviving and those who died during their hospital stay (63.5% vs 68.8%, P = .58).
  
  
  CONCLUSIONS
  Median times to the first antibiotic administration and last needed appropriate antibiotic administration were less than 3 and 5 hours, respectively; these times were similar between patients who survived and those who died during their hospital stay. Patients with a serum lactate level higher than 2.5 mmol/L were associated with a 2.5-times increased risk of mortality.
authors.affiliation: School of Pharmacy, Lake Erie College of Osteopathic Medicine, Bradenton, FL. Electronic address: Toniedgarrx@gmail.com.
authors.forename: Antonia L
authors.initials: AL
authors.lastname: Vilella
authors.affiliation: School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, TX. Electronic address: Charles.seifert@ttuhsc.edu.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Seifert
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D019344:Lactic Acid