Currently international guidelines for the management of sepsis and septic shock recommend antibiotic administration within 1 hour of recognition.
With the persistent problem of ED boarding, many patients with sepsis and septic shock remain in the ED long after the initial dose of broad-spectrum antibiotics.
A recent single center, retrospective cohort study demonstrated that 1 out of 3 patients with sepsis or septic shock experienced major delays in the time to the second dose of antibiotics. In fact, over 70% of patients who were given an initial antibiotic with a 6-hr recommended dosing interval experienced major delays.
Inpatient boarding in the ED was found to be an independent risk factor for major delays.
Take Home Point: Don't forget to write for additional doses of antibiotics in your boarding patients with sepsis.
Leisman D, et al. Delayed second-dose antibiotics for patients admitted from the emergency department with sepsis: prevalence, risk factors, and outcomes. Crit Care Med. 2017; 45:956-65.