June 30, 2021
From Hammer to Chisel: Refining the Time to Antibiotics Discussion in Sepsis ManagementBy Nirav Patel, MD
Timely administration of antibiotics is a cornerstone of sepsis management. However, identifying sepsis can be a diagnostic conundrum, and unbridled broad-spectrum antibiotic use has its own consequences. Furthermore, metrics surrounding antibiotic administration that attempt to direct process improvement, including the Centers for Medicare and Medicaid Services Severe Sepsis and Septic Shock Early Management Bundle (SEP-1), remain blunt tools that may insufficiently measure the challenges with sepsis diagnosis and treatment.
In this setting, Taylor and collaborators recently published in Critical Care Medicine an attempt to specify where potential opportunities may lie, specifically with delays in recognition of sepsis or administration of antibiotics. Using a 12-hospital emergency department retrospective cohort from 2014 to 2017, they found that the median time from triage to antibiotic administration was 3.4 hours, with a median recognition delay of 2.7 hours and a median administration delay of 0.6 hours. Both delays were associated with increased hospital mortality.
As the accompanying editorial notes, being able to target areas more specifically for sepsis care quality improvement that are more evidence-based is an important goal. As part of a number of suggested revisions to the SEP-1 measure, IDSA supports measuring the time from antibiotic order to infusion. Further research is needed prior to sharpening the metrics even further. However, this paper highlights an opportunity to achieve some precision and more targeted opportunities to improve sepsis care over the blunt instruments used today.
