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Published on: May 24, 2024
Identifying rate-limiting steps in the antimicrobial workflow for community-onset sepsis
Myung Jin Song1, Seunghyun Won2, Min Chul Kim1
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Summary
Identifying bottlenecks in antimicrobial delivery for community-onset sepsis is crucial. Early concurrent prescription of antimicrobials and blood cultures significantly shortens administration time.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Healthcare Operations
Background:
- Community-onset sepsis requires timely antimicrobial administration for improved patient outcomes.
- Understanding the workflow for antimicrobial delivery is essential to identify delays.
Purpose of the Study:
- To characterize the time intervals preceding antimicrobial administration in community-onset sepsis.
- To identify the rate-limiting steps in the antimicrobial workflow.
Main Methods:
- A multicentre prospective observational study involving 3,623 patients with community-onset sepsis in South Korea.
- Defined the antimicrobial workflow by five time points: time zero, blood culture prescription and collection, and antimicrobial prescription and administration.
- Categorized patients into three groups based on step sequence and analyzed four key intervals.
Main Results:
- Median time from time zero to administration varied by group: Group C (63.5 min), Group A (87.0 min), and Group B (115.0 min).
- Rate-limiting steps differed: 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, except for prescription-to-administration.
Conclusions:
- Rate-limiting steps in antimicrobial delivery are dependent on the clinical workflow.
- Early concurrent prescription of antimicrobials and blood cultures is linked to shorter antimicrobial administration times.
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