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Abstract

Introduction: Serious bacterial infections (SBIs) account for significant morbidity and mortality in children. There is evidence that prompt initiation of antibiotics for SBIs has decreased adverse outcomes in adults. However, data on prompt antibiotic administration has been found to be increasingly inconsistent. Hypothesis: Our hypothesis was that those children who received STAT antibiotics <60min would have a shorter length of stay (LOS) than those who did not. Methods: We conducted a retrospective chart review. STAT antibiotic orders were collected as part of hospital quality improvement initiative. Inclusion criteria were receiving STAT IV antibiotics, admission to the acute care floor or pediatric intensive care unit (PICU), and a principal discharge diagnosis of sepsis, bacteremia, meningitis, pneumonia, or fever and neutropenia. Other data was age and gender, time from order to administration, time from presentation to administration, LOS, Pediatric Early Warning System score (PEWS) if on acute care, and the Pediatric Logistic Organ Dysfunction score (PELOD) if admitted to the PICU. Results: There were 4,924 STAT antibiotic orders. 1375 patients met inclusion criteria diagnoses. Only 350 met all inclusion criteria. The average age was 6 years old. 48% were male. The mean LOS for acute care unit was 5.2 [4.7-5.8] days and 11.1 [8.9-13.9] for the PICU. On the acute care unit, patients who received antibiotics <60min were 1.35 times more likely to be discharged earlier (p=0.019). Average LOS for antibiotic administration <60 mins was 4.7 [4.1 – 5.4] days versus those who received >60 mins: 6.0 [5.1 – 7.0] days. In the PICU, the average LOS for those who received antibiotics <60 mins was 10.2 [8.0 – 12.8] days versus those who receive antibiotics >60 mins was 12.9 [10 – 16.7] days. Conclusions: In conclusion, in the acute care setting, delayed time to antibiotics of >60min was associated with increased LOS in patients with SBIs. In the critical care setting, delayed time to antibiotics of >60min was not associated with increased LOS in patients with SBIs. Delayed time to antibiotics of >60min was not associated with escalation of care.