(1433) The Impact of IV Push Antibiotics on Time to Administration in the ED

Introduction: Patients who present to the emergency department (ED) with sepsis or septic shock warrant antibiotic administration within one hour of recognition based on the 2021 Surviving Sepsis Campaign Guidelines. Intravenous push (IVP) administration of antibiotics has been shown to be a safe alternative to IV infusion (INF) administration. This study evaluated the transition to IVP antibiotics in a tertiary care ED to assess time to first antibiotic in patients with sepsis and septic shock.

Methods: This retrospective, single-center cohort study evaluated consecutive patients ≥18 admitted to the ED with sepsis and septic shock pre- vs. post-implementation of IVP antibiotics. Patients were excluded if they did not receive antibiotics, if antibiotics were not administered in the ED, or if they were pregnant. The primary objective, time to first antibiotic, was evaluated using the time from admission to antibiotic administration. Secondary objectives included ICU length of stay, in-hospital mortality, time to second antibiotic administration, time to pharmacist verification, and a comparison of these objectives between sepsis and septic shock.

Results: Of 1741 patients who were admitted to the ED with sepsis or septic shock between 4/2021 and 6/2023, 513 were included. The IVP cohort had a significantly higher number of septic shock patients and vasopressors use, otherwise, baseline characteristics were similar. IVP was associated with a shorter time to first antibiotic when compared to the INF cohort (98 min vs. 136 min, p = < 0.01). These results were consistent in patients with sepsis only (43 min reduction, p = < 0.01) and with septic shock (35 min reduction, p = < 0.01). IVP was also associated with a significantly shorter time to second antibiotics (162 min reduction, p = < 0.01). In hospital mortality, ICU length of stay, and time to pharmacist verification were not significantly different.

Conclusions: IVP was associated with a significant decrease in time to administration compared to INF. Due to this study’s retrospective nature, further studies may be warranted to fully measure the effect on mortality and related outcomes. However, this study suggests that IVP is an effective way to decrease time to antibiotic administration in this high mortality population.