Can pre-hospital administration reduce time to initial antibiotic therapy in septic patients?

Daniel Cudini; Karen Smith; Stephen Bernard; Michael Stephenson; Emily Andrew; Peter Cameron; Mark Lum; Andrew Udy; ARISE Investigators

doi:10.1111/1742-6723.13282

Can pre-hospital administration reduce time to initial antibiotic therapy in septic patients?

Emerg Med Australas. 2019 Aug;31(4):669-672. doi: 10.1111/1742-6723.13282. Epub 2019 Mar 28.

Authors

Daniel Cudini^{1

2}, Karen Smith^{2

3

4

5}, Stephen Bernard^{4

6}, Michael Stephenson^{1

2

4}, Emily Andrew³, Peter Cameron^{7

8}, Mark Lum⁹, Andrew Udy¹⁰; ARISE Investigators

Collaborators

ARISE Investigators:
V Bennett, J Board, P McCracken, S McGloughlin, V Nanjayya, A Teo, R Bellomo, S Bolch, G Eastwood, F Kerr, L Peak, H Young, J Edington, J Fletcher, J Smith, A Cross, D Flemming, M Grummisch, A Purdue, T Coles, H Connor, J Dennett, A Van Berkel, G Braitberg, B O'Bree, K Shepherd, S Vij, S Allsop, D Haji, K Haji, J Vuat, A Bone, T Elderkin, N Orford, M Ragg, J Dowling, P Galt, T Lamac, D Lightfoot, C Walker, C MacIsaac, K Gorman, A Jordan, L Moore, E Farone, J Holmes, J Santamaria, C Winter, S Bates, J Butler, C French, A Tippett

Affiliations

¹ Clinical Operations, Ambulance Victoria, Melbourne, Victoria, Australia.
² Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia.
³ Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia.
⁴ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ Discipline of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia.
⁶ Medical Directorate, Ambulance Victoria, Melbourne, Victoria, Australia.
⁷ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁸ Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
⁹ Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
¹⁰ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.

PMID: 30924278
DOI: 10.1111/1742-6723.13282

Abstract

Objective: To quantify the potential time saved with pre-hospital antibiotic therapy in sepsis.

Methods: Study data for adult patients transported by Ambulance Victoria (AV), and enrolled into the Australasian Resuscitation In Sepsis Evaluation (ARISE), were linked with pre-hospital electronic records.

Results: An AV record was identified for 240 of 341 ARISE patients. The pre-hospital case notes referred to potential infection in 165 patients. The median time to first antibiotic administration from loading the patient into the ambulance was 107 (74-160) min.

Conclusions: ARISE patients in Victoria were frequently identified pre-hospital. An opportunity exists to study the feasibility of pre-hospital antibiotic therapy.

Keywords: antibiotics; out of hospital; pre-hospital; sepsis; sepsis management.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Ambulances
Anti-Bacterial Agents / administration & dosage
Anti-Bacterial Agents / therapeutic use*
Emergency Medical Services* / methods
Female
Humans
Male
Middle Aged
Sepsis / drug therapy*
Sepsis / mortality
Sepsis / therapy
Survival Analysis
Time Factors
Victoria

Substances

Anti-Bacterial Agents

Grants and funding

Monash University/International