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

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

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.

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.

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.