Understanding Antibiotic Delays in Patients With Sepsis-Induced Hypotension at Michigan Hospitals

Document Type

Conference Proceeding

Publication Date

5-20-2025

Publication Title

Am J Respir Crit Care Med

Abstract

Introduction: Despite the importance of early antibiotics in sepsis, antibiotic administration is often delayed. We sought to understand factors associated with timely antibiotic administration in patients with sepsis-induced hypotension. Methods: This is a retrospective cohort study of adult patients hospitalized with community-acquired sepsis from 11/2020 to 5/2024 at 67 hospitals participating in the Michigan Hospital Medicine Safety Consortium Sepsis Initiative (HMS-Sepsis). HMS-Sepsis registry data are professionally abstracted, including patients' presenting symptoms as documented in provider notes. We included patients with sepsis (infection and acute organ dysfunction) and hypotension within 2 hours of presentation to ED. We excluded patients with positive COVID-19 or influenza testing. Antibiotics were considered timely if administered within 3 hours of presentation—a relaxed cut-off compared to Surviving Sepsis recommendations (antibiotics ≤ 1 hour of sepsis onset) to account for sepsis recognition time. We compared symptoms of patients receiving timely vs delayed antibiotics using Chi-squared tests. We used logistic regression to measure the association between patient factors and timely antibiotics with hospital as a random effect. Results: Of 6,759 HMS-Sepsis patients with sepsis-induced hypotension, 4,427 (65.5%) received timely antibiotics while 2,332 (34.5%) received delayed antibiotics. Median time from ED presentation to antibiotic delivery was 1.6 hours (IQR 1.1-2.2) vs 4.5 hours (IQR 3.6-6.7) in the timely vs delayed groups, respectively. Patients receiving timely antibiotics had different presenting symptoms: more frequent subjective fever (48.6% vs 36.9%, p< 0.01), altered mental status (63.2% vs 55.2%, p< 0.01), respiratory symptoms (71.9% vs 67.1%, p< 0.01), and less frequent GI symptoms (40.8% vs 46.8%, p< 0.01). Urinary symptoms were similar (23.9% vs 24.4%, p=0.62). In adjusted models, odds of timely antibiotics increased with male sex [aOR 1.13 (95% CI: 1.02, 1.27)], admission from a facility [aOR 1.32 (1.13, 1.55)], higher predicted mortality [aOR 1.72 (1.22, 2.42)], and subjective fever [aOR 1.40 (1.23, 1.58)]. Vital sign derangements on presentation (hypo/hyperthermia, tachycardia, tachypnea, hypoxia) were each associated with increased odds of timely antibiotics. Odds of timely antibiotics decreased with heart failure history [aOR 0.82 (0.72, 0.94)] and GI symptoms [aOR 0.85 (0.75, 0.96)]. While hospital-level variation was low (adjusted median OR: 1.02), at 5/67 (7.5%) hospitals < 50% of patients received timely antibiotics (Figure 1). Conclusion: This study provides insight into factors associated with antibiotic delays, highlighting the importance of subjective symptoms, which are often not captured in electronic databases, and possible gender and hospital disparities. Understanding risk factors for antibiotic delays is important for developing interventions to improve sepsis recognition.

Volume

211

First Page

2

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