2026 Southeastern Residency Conference

Background: Sepsis is a life-threatening emergency with the potential for high morbidity and mortality. Sepsis often has nonspecific symptoms; however timely recognition of infection-related symptoms is critical. Timing of antibiotic administration is directly linked to improved patient outcomes, whereas delay of subsequent antibiotic doses leads to unfavorable patient outcomes.1 This study aims to identify the presence of significant delays in second dose antibiotics following admission and the associated cause of delay.
Methods: This is an Institutional Review Board exempt, multicenter, retrospective chart review within the Baptist Health system. Patients who presented to an emergency department (ED) within the Baptist Health system were identified through an electronic report. A chart review was performed from August 2024 to January 2025 capturing patients with a sepsis diagnosis. The primary outcome was the rate of subsequent antibiotic doses given outside of a 25% variance of the initial antibiotic dosing interval. Secondary outcomes include degree of delays, cause of delays, and all-cause mortality.   
Results: A total of 295 patients were reviewed with 200 included. Eligible patients were female, of black ethnicity, with a median age of 64 years. The most common admitting diagnosis was community acquired pneumonia. All patients had an attributable source of infection, with 73% meeting at least 2 systemic inflammatory response syndrome (SIRS) criteria consistent with a sepsis diagnosis. Ceftriaxone was the most frequently administered first-dose antibiotic in the ED. Bacterial pneumonia was most likely to have combination empiric therapy with azithromycin while all other indications – including urinary tract infections, skin and soft tissue infections – were often paired with vancomycin. Upon admission, subsequent antibiotic selections included equal quantities of piperacillin-tazobactam and cefepime with a reduction in ceftriaxone continuations. The primary outcome of a greater than 25% variance in antibiotic administration was present in 30.5% of patients. Preemptive doses greater than 25% were present in 26.5% of patients and were most frequently with ceftriaxone. Delays greater than 25% were present in 4% of patients and most frequent with piperacillin-tazobactam dosed at an 8-hour interval. The degree of delay ranged from 26% – 101% and was most commonly due to ordering, followed by administration. Mortality rate present in the preemptive, in-range, and late groups was 28%, 9%, and 12.5%, respectively.
Conclusion: The importance of appropriate timing of subsequent antibiotics in septic patients cannot be overstated. While this study found a moderate incidence of variance in second-dose antibiotics, only 4% had the potential to experience significant harm due to delays greater than 25%. The Baptist Health System may benefit from additional education regarding the once-dose process in the ED to further reduce incidence of ordering delays. Additionally, pharmacy staff may benefit from education on recommended dosing intervals and appropriate timing of common antibiotics utilized in the ED for septic patients.