title: Time to Administration of Antibiotics among Inpatients with Severe Sepsis or Septic Shock.
abstract: BACKGROUND
  Current evidence suggests that administration of appropriate antibiotic therapy within 1 h after the onset of hypotension significantly improves mortality rates among patients with severe sepsis and septic shock.
  
  
  OBJECTIVE
  To determine the interval from recognition of severe sepsis or septic shock in inpatients to initial administration of antibiotic and to assess institutional compliance with the Surviving Sepsis Campaign's recommendation for early antibiotic therapy.
  
  
  METHODS
  A 6-month retrospective chart analysis was conducted to determine the interval from documented onset of hypotension to initial administration of antibiotic for patients with severe sepsis or septic shock. Patients who were admitted to a general medicine ward, a surgery ward, or the intensive care unit (ICU) of a 475-bed university-affiliated hospital and who met the criteria for severe sepsis or septic shock were eligible for inclusion. Patients who received antibiotics before meeting the criteria for severe sepsis or septic shock were excluded.
  
  
  RESULTS
  Charts for 100 patients with severe sepsis or septic shock were reviewed. The mean age was 69.0 years (standard deviation 18.7 years), and 56% were men. The median interval from onset of severe sepsis or septic shock to administration of antibiotic was 4.00 h (interquartile range [IQR] 1.80-6.45 h). The median interval from the time a physician ordered an antibiotic to administration of the drug was 1.28 h (IQR 0.57-3.05 h). The interval between ordering and administration differed significantly for patients on the wards (5.67 h), those with onset in the ICU (4.00 h), and those with onset in the emergency department (3.28 h) (p = 0.039). The overall survival rate was 56%.
  
  
  CONCLUSIONS
  At the study hospital, the interval from onset of severe sepsis or septic shock to initial administration of antibiotic to inpatients exceeded the 1-h period recommended by the Surviving Sepsis Campaign. These results will be used as a baseline for future quality assurance and improvement initiatives aimed at minimizing the time to antibiotic administration for this group of patients, who are at high risk of death.
authors: , BScPhm, ACPR, RPh, is with Mount Sinai Hospital, Toronto, Ontario.
authors: Katie
authors: K
authors: Mok
authors: , MD, MSc, FRCP, is with Mount Sinai Hospital, Toronto, Ontario.
authors: Michael D
authors: MD
authors: Christian
authors: , PharmD, RPh, is with Mount Sinai Hospital, Toronto, Ontario.
authors: Sandra
authors: S
authors: Nelson
authors: , BScPharm, PharmD, RPh, is with Mount Sinai Hospital, Toronto, Ontario.
authors: Lisa
authors: L
authors: Burry
keywords: antibiotics; septic shock; severe sepsis; timing