Assessment of Initial Sepsis Antibiotic Administration Practices Following Compatibility Education

Introduction: The Surviving Sepsis Guidelines recommend broad-spectrum antibiotics within 1-3 hours of possible sepsis. In August 2024, real time pharmacist-led written and verbal education was implemented, encouraging the use of concomitant antibiotic administration or gram-negative agent prioritization if agents were incompatible. This pre/post study assessed the effect of the pharmacist’s IV-line compatibility intervention on time to first-dose antibiotics in the emergency department (ED).


Methods: This prospective, single-center study was conducted in the ED of an 826-bed tertiary academic medical center. Patients were included if they received multiple concomitant broad-spectrum IV antibiotics in the ED. Patients were excluded if they lacked an ICD-10 diagnosis of sepsis or received antibiotics prior to arrival. A pre-intervention (3/1/2024–8/13/2024) group (pre) and post-intervention (8/14/2024-1/31/2025) group (post) comparison was conducted.
The major outcome was time to first-dose administration of a multi-antibiotic regimen. Minor outcomes included incidence of compatible first-dose antibiotics administered concomitantly, administration within 1 and 3 hours, and appropriate prioritization when administered separately. Chi-square and Mann-Whitney U tests were used as appropriate.


Results: 299 patients were included with 140 in the pre and 159 in the post groups. Vancomycin (96.4% vs 95.0%) and cefepime (77.9% vs 66.6%, p=0.03) were ordered most frequently. The median time to first-dose was 56 minutes pre vs 46 minutes post (p=0.19). There was no statistically significant difference in administration within 1 hour, 3 hours, nor incidence of compatible first-dose antibiotics administered concomitantly. There was a significant decrease in appropriate prioritization in administration of incompatible agents in the post group (90.0% vs 67.8%, p=0.003).


Conclusions: A pharmacist-led IV-line compatibility educational intervention demonstrated no improvement in time to first-dose antibiotics. A major limitation was a national fluid shortage that occurred during the study period that led to an increase in incompatible cefepime products being utilized. Further studies are warranted to better elucidate the impact of pharmacist intervention on time to first-dose antibiotic administration in sepsis.