439: TIME TO FIRST ANTIBIOTICS ADMINISTRATION IN THE ICU

Abstract

Introduction: The Surviving Sepsis Guidelines recommend IV antibiotics (ABX) be administered within 1 hour to patients with sepsis or septic shock. Delays in ABX administration in this patient population have been shown to increase mortality. We sought to determine the time to first IV ABX in ICU patients and to identify barriers resulting in delayed IV ABX administration. Methods: This was an IRB-approved retrospective review conducted between May 2021 and July 2021 involving adult patients across three ICUs (2 medical and 1 surgical) at an academic medical center. All patients who received a first-dose IV ABX in the ICU were included. Descriptive statistics were used to characterize the data. Mann-Whitney U test was used to compare the median times to administration between IV ABX dispensed from an automated dispensing cabinet (ADC) versus those from the pharmacy (PHARM). Results: A total of 250 first IV ABX doses (84% MICU and 16% SICU) in 90 patients were included. There were an average of 2.8 first doses of IV ABX per patient during the study period, half of which were dispensed from ADC and half from PHARM. The median time from order input to patient administration (n=211) was 68 min (40-109). The median time from order input to patient administration was longer if the IV ABX was dispensed from PHARM vs ADC [89 min (60-128) vs 54 min (29-76); p< 0.001]. Vancomycin also had a longer median time from order input to administration if dispensed from PHARM vs ADC [92 min (58-154) vs 39 min (24-71); p< 0.001]. A total of 88 IV ABX were dispensed within 60 min, with 82% from ADC vs 18% from PHARM, 81 ABX were dispensed within 60-120 min, with 65% from ADC vs 35% from PHARM, and 42 IV ABX were administered >120 min, with 59% from ADC vs 41% from PHARM (Χ2=9.42; p=0.009). Conclusions: The median time to IV ABX administration in the ICU was near recommendations from guidelines. One limitation was the inability to classify patients as having sepsis or septic shock. Delays in time to IV ABX administration were primarily observed with medications dispensed by PHARM as compared to ADC.