Impact of extended emergency department stay on antibiotic re-dosing delays and outcomes in sepsis

Background: For patients with sepsis and septic shock, the initial administration of antibiotics should occur as soon as possible, preferably within one hour of sepsis recognition. While clinicians are focused on providing first-doses of antibiotics quickly upon presentation, re-dosing issues may arise in patients who have an extended emergency department (ED) length of stay (LOS). Limited studies have been conducted that assess the impact of re-dosing delays. The purpose of this study was to assess the association of an extended ED LOS >= 6 h with antibiotic re-dosing delays in patients with sepsis and examine outcomes. Methods: A retrospective cohort study comparing patients with sepsis with an ED LOS of <6 h to those with an ED LOS of >= 6 h was performed between March 2018 and February 2020. Patients >= 18 years old admitted from the ED with sepsis or septic shock were included. The primary outcome was incidence of delay to the second dose of antibiotics in those with an extended ED LOS compared to those without. Secondary outcomes included intensive care unit (ICU) LOS, hospital LOS, rate of transfer from non-ICU to ICU settings, incidence and duration of mechanical ventilation, and in-hospital mortality. An exploratory analysis compared outcomes in patients with and without a re-dosing delay. Results: Of the 128 patients included, 99 patients had an ED LOS < 6 h and 29 patients had an ED LOS >= 6 h. A delay to second dose of antibiotics occurred in 30 (30.3%) patients in the ED LOS < 6 h group versus 7 (24.1%) patients in the ED LOS >= 6 h group(p = 0.52). Secondary outcomes did not significantly differ between the two groups. Inhospital mortality was numerically higher in those with a re-dosing delay when compared to those without in the exploratory analysis (18.9% vs. 8.8%, p = 0.11). Conclusion: There was no statistically significant difference in the incidence of delays to the second dose of antibiotics among patients with sepsis with an ED LOS of <6 h versus those with an ED LOS of >= 6 h. The high incidence of antibiotic re-dosing delays in both groups, indicates an overall need for improved transitions of care in the ED sepsis population. (C) 2022 Elsevier Inc. All rights reserved.