Descriptive analysis of timing of administration of antimicrobial therapy for septic shock in a medical-surgical intensive care unit

摘要

Background: Septic shock remains a major cause of morbidity and mortality in intensive care units worldwide. According to the guidelines of the Society of Critical Care Medicine, antimicrobial therapy should be initiated within the first hour after recognition of severe sepsis. Furthermore, initiation of antibiotic administration within this timeframe has been associated with better survival to hospital discharge among adult patients, whereas survival declined with delays beyond 1 hour. We undertook this study to evaluate the timing of administration of antibiotics in relation to diagnosis of septic shock in an 11-bed medical-surgical intensive care unit (ICU) within a community hospital to compare the findings with international guidelines and best evidence. Methods: We performed a retrospective chart audit for adult patients (>18 years of age) with septic shock who were admitted to the Burnaby Hospital medical-surgical ICU between January and June 2006. We extracted from each chart the time of initiation of effective antibiotic therapy following onset of recurrent or persistent hypotension. We also attempted to identify factors contributing to a delay (if any) in the administration of antibiotic therapy. Results: Of 233 patients initially identified, 29 met the inclusion criteria. The mean delay from onset of persistent or recurrent hypotension to initiation of effective antibiotic therapy for these patients was 2.63 hours. Only 8 (28%) of the patients received effective antibiotic therapy within the first hour after development of hypotension.Conclusions: The mean time to administration of appropriate antibiotic therapy for patients with septic shock was much longer than the internationally recommended time of 1 hour or less. This delay may contribute to increased mortality in this patient population.