Predictors for delayed antibiotic administration among bacteraemic patients in the Emergency Department: Differences between medical and surgical interns.

ABSTRACT

BACKGROUND: Bloodstream infections (BSIs) have been associated with high mortality. The aim of the study was to identify predictors of early (within 3 hours from triage) administration of first antibiotic dose among patients evaluated in the Emergency Department (ED) with BSI and their role in mortality. MATERIALS AND METHODS: All adult patients with BSI at the ED of the Hospital of Jura, Switzerland during a 3 year period (July 2014 to June 2017) were included. RESULTS: Among 364 BSI, the most common sites of infection were urinary tract (39.6% of BSIs), lower respiratory tract (15.4%), intra-abdominal (15.4%) and primary BSI (9.1%). One-hundred-seventy-eight patients (48.9%) received the first antibiotic dose within 3 hours from triage. Multivariate analysis identified evaluation by internal medicine intern, triage scales 1 and 2, as predictors of early antibiotic administration, while, primary BSI was associated with delayed antibiotic administration. Thirty-day mortality was 12.9% (47 patients). Charlson comorbidity index, septic shock, low respiratory tract infection were independently associated with mortality, while antibiotic administration within 3 hours from triage and source control within 48 hours from triage were associated with survival. CONCLUSIONS: The majority of patients received the first antibiotic dose after 3 hours Patients evaluated by surgical interns had a significant delay in administration of antibiotics as compared to those treated by medical interns.