Antimicrobial Administration Delays for Patients with Suspected Sepsis in a Canadian Emergency Department: Prevalence and Risk Factors.

Abstract

Background: For patients with sepsis, timely administration of antimicrobials is imperative, with evidence demonstrating that delays may be associated with an increase in mortality.

Objective: To determine whether antimicrobial administration is delayed among patients with sepsis admitted through the Queen Elizabeth II Health Sciences Centre Emergency Department (QEII-HSC-ED) in Halifax, Nova Scotia.

Methods: A single-centre, retrospective health records review was conducted for adult patients with sepsis admitted through the QEII-HSC-ED between January 1, 2021, and December 31, 2022. Differences between groups with and without antimicrobial administration delays were compared by univariate analysis, and an adjusted multivariate regression was completed to examine associations between risk factors and significant delays.

Results: A total of 275 patient encounters were included in the analysis, accounting for a total of 1208 antimicrobial doses: 275 first doses and 933 subsequent doses. Of the 275 patient encounters, 216 (78.5%) had at least one significant dose delay; 135 (49.1%) of the encounters had delay of the first dose, and 169 (61.5%) had delay of a subsequent dose. Of the 933 subsequent doses administered, 276 (29.6%) had a significant delay. Relative to patients admitted to a medicine service, surgical patients had reduced odds of experiencing significant delay of a subsequent dose (odds ratio 0.25, 95% confidence interval 0.08-0.77).

Conclusions: Many patients with sepsis admitted through the QEII-HSC-ED experienced significant delays in administration of first and/or subsequent doses of antimicrobial therapy, which may have increased their risk of negative outcomes. These results can be used to develop future initiatives aimed at improving time to administration of antimicrobials for patients with sepsis admitted to the study institution.