2025 Southeastern Residency Conference

Title: Impact of Surge Capacity on Time to Subsequent Dose of Antibiotics for Sepsis Patients in the Emergency Department
Authors: Stephanie Knode, Chelsie Sanders, Ginger Gamble, Amy Campbell; ECU Health Medical Center- Greenville, NC
 
Background/Purpose:
Antibiotics are a cornerstone of sepsis treatment, however there is no guidance on the impact of subsequent antibiotic delays on clinical outcomes. Previous studies have evaluated the impact of delays and discussed external factors that may influence these delays. No current studies have evaluated how surge capacity may impact delays in second dose antibiotics. Therefore, the objective of this study is to compare the impact of red/disaster capacity versus green/yellow capacity on delays in second dose antibiotics for sepsis patients in the emergency department.
 
Methods:
Eligible patients are 18 years or older with a diagnosis of sepsis who received at least two doses of the same intravenous antibiotic, with the first dose given in the emergency department. Antibiotics needed to have a 6-, 8-, or 12-hour administration frequency. Patients were excluded if they expired prior to the second dose of antibiotics, were pregnant or a prisoner, received their first dose of antibiotics prior to ED arrival, or if there was escalation or change in empiric coverage between the first and second dose of antibiotics. This study is a single-center, retrospective, observational review with patient data obtained through Vizient and capacity data through hospital operations.
 
Results:
The initial Vizient data pull identified 1292 patients potentially eligible for this study, of which 1000 patients were excluded. The most common reasons for exclusion were receipt of 24 hour dosed antibiotics and change in empiric antibiotics between the first and second dose. 292 patients who received 302 antibiotics were eligible for inclusion in this study. Baseline characteristics were similar between groups, including age, sex, weight, renal function, and the choice of empiric antibiotics. The primary outcome of incidence in delay of second dose antibiotics was seen in 130 patients (68.78%) in the green and yellow capacity group versus 66 patients (58.41%) in the red and internal disaster capacity group, with a p-value of 0.081. Hospital mortality, 7-, 30-, and 90-day mortality were not significantly different between groups, nor were need for mechanical ventilation, admission to an intensive care unit (ICU), or hospital and ICU lengths of stay.
 
Conclusions:
Red/disaster capacity did not have a significant impact on the incidence of second dose antibiotic delays versus green/yellow capacity for sepsis patients in the emergency department.