Abstract
It is unclear whether antimicrobial timing for sepsis has changed outside of performance incentive initiatives. To examine temporal trends and variation in time-to-antibiotics for sepsis in the US Department of Veterans Affairs (VA) health care system. This observational cohort study included 130 VA hospitals from 2013 to 2018. Participants included all patients admitted to the hospital via the emergency department with sepsis from 2013 to 2018, using a definition adapted from the Centers for Disease Control and Prevention Adult Sepsis Event definition, which requires evidence of suspected infection, acute organ dysfunction, and systemic antimicrobial therapy within 12 hours of presentation. Data were analyzed from October 6, 2020, to July 1, 2021. Time from presentation to antibiotic administration. The main outcome was differences in time-to-antibiotics across study periods, hospitals, and patient subgroups defined by presenting temperature and blood pressure. Temporal trends in time-to-antibiotics were measured overall and by subgroups. Hospital-level variation in time-to-antibiotics was quantified after adjusting for differences in patient characteristics using multilevel linear regression models. A total of 111 385 hospitalizations for sepsis were identified, including 107 547 men (96.6%) men and 3838 women (3.4%) with a median (interquartile range [IQR]) age of 68 (62-77) years. A total of 7574 patients (6.8%) died in the hospital, and 13 855 patients (12.4%) died within 30 days. Median (IQR) time-to-antibiotics was 3.9 (2.4-6.5) hours but differed by presenting characteristics. Unadjusted median (IQR) time-to-antibiotics decreased over time, from 4.5 (2.7-7.1) hours during 2013 to 2014 to 3.5 (2.2-5.9) hours during 2017 to 2018 (P < .001). In multilevel models adjusted for patient characteristics, median time-to-antibiotics declined by 9.0 (95% CI, 8.8-9.2) minutes per calendar year. Temporal trends in time-to-antibiotics were similar across patient subgroups, but hospitals with faster baseline time-to-antibiotics had less change over time, with hospitals in the slowest tertile decreasing time-to-antibiotics by 16.6 minutes (23.1%) per year, while hospitals in the fastest tertile decreased time-to-antibiotics by 7.2 minutes (13.1%) per year. In the most recent years (2017-2018), median time-to-antibiotics ranged from 3.1 to 6.7 hours across hospitals (after adjustment for patient characteristics), 6.8% of variation in time-to-antibiotics was explained at the hospital level, and odds of receiving antibiotics within 3 hours increased by 65% (95% CI, 56%-77%) for the median patient if moving to a hospital with faster time-to-antibiotics. This cohort study across nationwide VA hospitals found that time-to-antibiotics for sepsis has declined over time. However, there remains significant variability in time-to-antibiotics not explained by patient characteristics, suggesting potential unwarranted practice variation in sepsis treatment. Efforts to further accelerate time-to-antibiotics must be weighed against risks of overtreatment.
Highlights
In the most recent years (2017-2018), median time-to-antibiotics ranged from 3.1 to 6.7 hours across hospitals, 6.8% of variation in time-to-antibiotics was explained at the hospital level, and odds of receiving antibiotics within 3 hours increased by 65% for the median patient if moving to a hospital with faster time-to-antibiotics
Temporal Trends and Hospital Variation in Time-to-Antibiotics for Treatment of Sepsis. This cohort study across nationwide Veterans Affairs (VA) hospitals found that time-to-antibiotics for sepsis has declined over time
In a multilevel model adjusted for patient characteristics, longer time-to-antibiotics was associated with higher in-hospital mortality (OR per 1-hour from emergency department (ED) presentation, 1.01 [95% CI, 1.00-1.02]; P = .02) and 30-day mortality (OR per 1-hour from ED presentation, 1.02 [95% CI, 1.01-1.02]; P < .001), consistent with prior studies.[9,10,11]
Summary
Life-threatening organ dysfunction secondary to infection, is a common, costly, and lethal syndrome, affecting more than 1.7 million patients annually in the United States.[1,2,3,4] Sepsis quality improvement initiatives focus on rapid identification and administration of antimicrobials and fluids because there is higher quality evidence supporting these practices.[5,6,7,8] faster receipt of antimicrobial therapy has been associated with improved survival, for patients who present with shock.[9,10,11]Over the past 15 years, there has been growing attention to the importance of timely antimicrobial administration in sepsis. Life-threatening organ dysfunction secondary to infection, is a common, costly, and lethal syndrome, affecting more than 1.7 million patients annually in the United States.[1,2,3,4] Sepsis quality improvement initiatives focus on rapid identification and administration of antimicrobials and fluids because there is higher quality evidence supporting these practices.[5,6,7,8] faster receipt of antimicrobial therapy has been associated with improved survival, for patients who present with shock.[9,10,11]. The US Center for Medicare and Medicaid Services’ SEP-1 performance measure and New York state’s “Rory’s Regulations” both incentivize timely antimicrobial administration.[10,12,13] These and other sepsis performance improvement programs have resulted in faster administration of antimicrobials for their target populations, with associated improvements in inpatient sepsis survival over time.[14,15,16] it is unclear whether antimicrobial timing for sepsis has changed outside of these formal performance incentive programs, and whether temporal trends in time-to-antibiotics have differed across hospitals or among patients who present with more obvious signs of sepsis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
