O52 – Early appropriate empiric antimicrobial prescribing in septic patients presenting to the emergency department does not lead to decreased mortality

Author(s):
James Gilmore, Christopher Adams, Reza Askari, Brigham and Women

Background: The 2012 Surviving Sepsis Campaign Guideline (SSC) recommends administration of broad-spectrum antimicrobials within 1 hour of recognition of severe sepsis and septic shock. The SSC also recommends that empiric regimens be composed of one or more drugs that have activity against all likely pathogens and that penetrate in adequate concentrations into the presumed source of sepsis. The purpose of this phase I analysis is to assess the appropriateness of empiric therapy based on culture results in patients presenting to the emergency department (ED) with sepsis, severe sepsis or septic shock at a tertiary academic medical center.

Hypothesis: Appropriate empiric prescribing of antimicrobials improves survival in septic patients presenting to the emergency department.

Methods: We conducted a retrospective, single-center analysis of adult patients admitted to our tertiary care academic medical center via the emergency department diagnosed with sepsis, severe sepsis or septic shock. We screened 786 patients identified by a hospital claims database discharged from the hospital with ICD-9 charge codes for sepsis, severe sepsis or septic shock between January 1st 2012 and December 31st 2012.

Results: 271 patients met the criteria for inclusion. Overall mortality rate was 20.3 %. 87 patients (32%) had no positive culture growth during admission and were excluded 100 cultures grew gram positive organisms, 96 cultures grew gram (-) organisms, 11 anerobic organisms, 15 fungal organisms, and 5 cultures with positive viral growth. Of patients with positive cultures, 113/ 184 (61%) were treated appropriately initially based on final culture results. Mortality of those treated appropriately was (23/113, 20%) and did not differ significantly from those who were not treated appropriately (16/71, 22%), p=0.72. Mean time to antibiotic administration from bed placement was 2.2 hrs and 1.5 hrs from MD assessment.

Conclusions: Our data failed to show a mortality benefit to early appropriate empiric antibiotic administration in patients with sepsis, severe sepsis or septic shock. Despite these findings our planned phase II analysis will focus on improving our overall appropriate antimicrobial prescribing.