(844) Time to Antibiotic Administration in Children With Septic Shock and Associated Outcomes

Introduction: Sepsis is a leading cause of morbidity and mortality in children. The mainstay of early management of sepsis is rapid volume resuscitation and timely administration of antibiotics. The objective of this study was to assess the association between time to antibiotic administration and patient outcomes.

Methods: Children under 18 years with a sepsis diagnosis, a systolic blood pressure (SBP) less than the normal 5% parameter per the PALS guidelines within 48 hours of admission, admitted to the ICU or intermediate units or received 2 or more fluid boluses and received antibiotics within the first 24 hours were included. All study variables were extracted from the EMRs of pediatric patients admitted between 01/01/2012 and 12/31/2023 with a combination of healthcare analytics and manual chart audits. Variables collected were related to patient vitals, fluid administration, inotropic support, antimicrobial therapy, and outcomes. Relative times were calculated in minutes from time of ED admission. The time to normalization of SBP (> 5th percentile for age-based standards per PALS guidelines for 6 or more hours) was compared between children receiving antibiotics within 60 minutes of admission or later.

Results: A total of 155 patients (newborns: 22, 20 infants: 20, 1-10 years: 67, and 11-17 years: 46) met the study criteria, of which 75 were males (48%). Fifty (32.3%) patients were started on vasopressors. Overall mortality was 3.9% (6/155). The median hospital length of stay was 8 days (IQR 4, 16). 103 (66.5%) patients were admitted to the ICU, with a median ICU length of stay of 4.6 (IQR 1.9, 11.9) days. The median time to antibiotic administration (actual patient start time) was 180 (IQR 101, 344) minutes, with only 10 patients (6.5%) receiving antibiotics within one hour of hospital arrival. The median time for normalization of SBP was 6 hours (IQR 6, 10; n=152). There was no correlation between the time to antibiotic start (minutes) and normalization of SBP (hours) (r=-0.11, p=0.1866) or with hospital length of stay (days) (r=-0.09, p=0.2529).

Conclusions: Few patients admitted with sepsis receive antibiotics within 60 minutes of arrival. However, this study did not demonstrate an association between the measured outcomes and the timing of antibiotic administration.