title: Impact of an Antibiotic-specific Sepsis Bundle on Appropriate and Timely Antibiotic Administration for Severe Sepsis in the Emergency Department.
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.
authors.affiliation: Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Kalich
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Maguire
authors.affiliation: Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Campbell-Bright
authors.affiliation: Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Abhi
authors.initials: A
authors.lastname: Mehrotra
authors.affiliation: University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: Tom
authors.initials: T
authors.lastname: Caffey
authors.affiliation: University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Tulu
authors.affiliation: University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: Feng-Chang
authors.initials: FC
authors.lastname: Lin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Carson
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy*; D012772:Shock, Septic / Q000188:drug therapy; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic; early goal-directed therapy; quality improvement; sepsis; sepsis bundle; timing