Antimicrobial stewardship interventions reduce the time to the first antibiotic administration in septic patients in ICUs: regional multicenter study in 7 Latin American high-complexity hospitals

Abstract

Delay in the initial administration of antimicrobials is one of the strongest predictors for mortality for septic patients in the intensive care unit (ICU). Given the different logistics among hospitals for antibiotic administration, this delay can take hours. As antibiotic administration involves care coordination and the participation of different team members, education and the antimicrobial stewardship (AMS) program play a key role in reducing these times. This study evaluated the time between the initial prescription and the effective administration of antibiotics for ICU patients in seven Latin American hospitals, before (pre-) and after (post-I and post-II) the implementation of a tailored educational approach. After establishing a baseline measurement (pre-), we implemented a tailored educational intervention directed to the ICU team including nurses, specialists, pharmacists, and the members of the AMS team. Then, we conducted a post-intervention measurement after a 3 month period (post-I) and repeated it after a 1 year period (post-II). During the pre-interventional phase, the hang time varied between 88 and 178 min, reporting an adherence to the 1 hour bundle of 33.8%. For the post-I, it significantly reduced with time variations between 46 and 104 min, showing an increase of 54.9% in adherence. After 1 year, in post-II, a persistent effect of shorter administration time was observed, varying between 49 and 109 min, increasing the adherence to 59.6%. Our results highlight that an active and tailored multidisciplinary AMS educational process incorporating antibiotic hang time protocols and including multidisciplinary healthcare teams involved in coordinating sepsis care decreases the administration time of antibiotics in Latin American hospitals with limited resources.