2268. Antibiotic Stewardship Initiative to identify and optimize antibiotic administration hang-time in 7 intensive care units (ICU) hospitals in Latin America
Authors: Pallares Christian , Goff Debra A , García Juan Carlos , De La Cadena Elsa , Cornistein Wanda , Santonato Daniela , Boldim Diogo , Toledo Itaivet , Ahumada Rodrigo , Valdebenito Nicolás , Chaverri Jorge , Castañeda-Méndez Paulo , Vente Elsa Yasmín , Viveros Sara María Cobo , Hercilla Luis , Chong Katty , Moreno Vanessa , Villegas María Virginia 
Published: November 2023

Background

Septic shock studies have identified that delay to the initial antimicrobial administration is the strongest predictor of survival. With every hour of delay mortality increases by 7.6%. The time from the written antibiotic order to intravenous administration or “hang-time” can be several hours due to logistics within the hospital. As the optimization of the antibiotic administration involves the participation of a team in the ICU, Antimicrobial Stewardship Programs (ASP) play an important role in reducing this gap. The present study sought to determine the time between the prescription and the infusion of the antibiotic in 7 Latin American ICU that are implementing ASPs.

Methods

Prevalence study between 2021-2022 in 7 hospitals (Argentina, Brazil, Chile, Costa Rica, Peru, Mexico and Colombia). Hang-time was defined as the time elapsed from the written antibiotic order to actual IV administration. Hang-time compliant was defined as antibiotic administration within an elapsed time of 1 h from the written antibiotic order. Any patient with a suspected infection in the ICU (sepsis and/or septic shock secondary to urinary, intra-abdominal, soft tissue infections and pneumonia), who had a first dose of the antibiotic was included. Patients with incomplete medical records or who died before the administration of the first dose were excluded. For the descriptive analysis, the average of the time difference between the formulation versus the administration of the treatment was determined, as well as the adherence to the administration of the antibiotic in the first hour after being formulated.

Results

1207 prescriptions were evaluated. The most common diagnose was sepsis and septic shock from urinary and pulmonary source. Hangtime adherence was 38.5% (22.5%-74.0%). The time range was 2 to 1080 minutes.

HANGTIME RESULTS BY COUNTRY

Conclusion

The administration of antibiotics during the first hour in ICU patients was not an adherent practice despite being a risk factor for mortality. A stewardship process improvement protocol with physicians, pharmacists, and nursing collaboration has been developed to improve the hang-time of antibiotics in patients with sepsis. ASPs with limited resources should consider implementing hang-time protocols. Phase 2 will measure compliance of the hang-time protocol and mortality.

Disclosures

Christian Pallares, MD, MSc, 3M: Advisor/Consultant|3M: Honoraria|MSD: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Westquímica: Advisor/Consultant|Westquímica: Grant/Research Support|Westquímica: Honoraria Jorge Chaverri, n/a, Pfizer: Advisor/Consultant|Pfizer: Honoraria María Virginia Villegas, n/a, MSD: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Westquímica: Advisor/Consultant|Westquímica: Grant/Research Support|Westquímica: Honoraria