Identifying rate-limiting steps in the antimicrobial workflow for community-onset sepsis.

Abstract

Objectives: To characterize time intervals preceding antimicrobial administration in community-onset sepsis and identify rate-limiting steps.

Methods: In this multicenter prospective observational study of patients with community-onset sepsis in South Korea (June 2020-December 2023), the antimicrobial workflow was defined by five time points: time zero, blood culture prescription and collection, and antimicrobial prescription and administration. Patients were categorized into three groups by step sequence, and four key intervals were analyzed.

Results: Among 3623 patients (mean age 74.3 ± 13.0 years; 56.6% male), 1838 (50.7%) were assigned to Group A (antimicrobials and cultures prescribed before culture collection), 1517 (41.9%) to Group B (cultures obtained before antimicrobial prescription), and 268 (7.4%) to Group C (antimicrobials given before culture collection). Median time from time zero to administration was shortest in Group C (63.5 min), then Group A (87.0 min) and Group B (115.0 min). The rate-limiting step differed by group: prescription-to-administration in Group A, time-zero-to-prescription in Group B, and culture prescription-to-collection in Group C. Septic shock was associated with shorter intervals overall, except prescription-to-administration, which was unchanged.

Conclusion: Rate-limiting steps in antimicrobial delivery differ by clinical workflow. Early concurrent prescription of antimicrobials and blood cultures was associated with shorter time to antimicrobial administration.