2025 Southeastern Residency Conference

Title 


Evaluation of First Dose Intravenous Push Antibiotics in Emergency Department Sepsis Patients 


Authors 


William Markle, John Norris, Matt Bamber, Caitlin Rousseau


Objective 


Evaluate the effect of intravenous push (IVP) antibiotics on time to antibiotic administration and patient outcomes in emergency department sepsis-patients. 


Self-Assessment Question 


Surviving Sepsis Campaign recommends to administer antibiotics within 1 hour of sepsis recognition. Which of the following antibiotics should only be reconstituted with 0.9% sodium chloride? 


Ceftriaxone 


Cefepime 


Piperacillin/Tazobactam 


Meropenem 


Background 


Current guideline recommendations highlight the importance of timely intravenous (IV) antibiotic administration as an effective intervention in reducing sepsis-related mortality. However, timeliness of IV piggyback administration can be challenging due to preparation of antibiotics and infusion times of multiple medications. IVP antibiotics have been shown to reduce time from order to administration while having similar pharmacodynamic and adverse event profiles, but their effects on patient outcomes are not well known. The purpose of this study is to evaluate the effects of first dose IVP antibiotics on time to administration and patient outcomes in emergency department sepsis-patients. 


Methods 


This study did not require IRB approval. This pre-post study consisted of a retrospective chart review of patients aged ≥18 years who presented to the emergency department of FirstHealth Moore Regional Hospital and received IV piggyback (IVPB) beta-lactam antibiotics for sepsis or septic shock from June 2024 through August 2024. Following implementation of first dose IV push antibiotics in our emergency department, a second retrospective chart review was performed on patients aged ≥18 years who presented to the emergency department of FirstHealth Moore Regional Hospital and received IVP beta-lactam antibiotics for sepsis or septic shock from January 2025 through February 2025. Patients were excluded from both retrospective chart reviews if they were aged <18 years, pregnant, incarcerated, received oral antibiotics in the emergency department, or received potentially effective antibiotics for ≥48 hours within 7 days prior to presentation. The primary outcome is time from physician order entry to receipt of appropriate antibiotics. Secondary outcomes are hospital and ICU length of stay and in hospital mortality. Prior to IVP implementation a new triaging process was implemented in the emergency department that may have led to delays in the administration of antibiotics. To account for the confounder of patients diagnosed with sepsis through this triaging process, a subgroup analysis was performed that included only patients diagnosed with sepsis through our acute care process. 


Results 


There were 104 patients included in the final analysis; 49 patients in the IVPB group and 55 patients in the IVP group. The median time to antibiotic administration in the IVPB group was significantly faster than in the IVP group, 37 minutes versus 54 minutes (p= 0.0373). There were no significant differences in the secondary outcomes. There were 95 patients included in the subgroup analysis; 49 patients in the IVPB group and 46 patients in the IVP group. The median time to antibiotic administration in the IVPB group was not significantly faster than in the IVP group, 37 minutes versus 45.5 minutes (p= 0.4675). There were no significant differences in secondary outcomes. 


Conclusion 


In the overall study population, we observed a significantly faster time to administration in patients who received IVPB antibiotics. We attributed this to the implementation of a new triaging process which rapidly triages patients presenting from the emergency department lobby and potentially leads to delay in medication administration. When comparing IVPB patients to the subgroup of IVP patients that were evaluated through our acute care process, we observed no difference in antibiotic administration time. Future work will seek to evaluate the impact of this new triaging process on delays in patient care.