Patient Safety and Quality
Background: Timely dosing of antibiotics is of critical importance in the treatment of multiple infectious diseases. However, in an era of increased emergency department (ED) boarding times, adherence to appropriate repeat antibiotic dosing can be challenged. The study goal was to identify factors associated with poor redosing compliance and the effects on clinical outcomes in an effort to guide potential intervention targets to improve compliance.
Methods: We performed a retrospective cohort study of patients admitted to five EDs (three academic, two non-academic) in a single healthcare system during the year 2018. All admitted patients aged 18 years or older who received two doses of the same intravenous antibiotic, with at least the first dose delivered in the ED prior to admission, were included. Patients with end stage renal disease, cirrhosis and extremes of weight were excluded given the individualized antibiotic dosing regimens required. Delay of antibiotic delivery by greater than 25% of the recommended delivery frequency was deemed noncompliant. Risk factors and outcomes for noncompliance were evaluated.
Results: A total of 6408 occurences of second antibiotic dose delivery met study criteria. 3231 (50.4%) were female and overall mean age was 60.2 +/- 19.5 years. Noncompliant delivery of the second dose occurred in 1176 (18.4%) of cases. Significant delay in additional doses of antibiotics was found for males (OR 1.23, 95%CI 1.1-1.4), teaching hospitals (OR 2.2, 95%CI 1.9-2.6), recommended dosing frequencies less than 12 hours (OR 12, 95%CI 10.1-14.2) and patients receiving the second dose while in the ED (OR 1.4 95%CI 1.2-1.7). Patients not receiving timely antibiotics had increased in hospital mortality (OR 1.8, 95%CI 1.3-2.4) and risk of critical care transfer within 12 hours of leaving the ED (OR 1.3, 95%CI 1.1-1.5). Antibiotic compliance had no effect on critical care needs while in the ED (OR 1.4 95%CI 0.9-2.0).
Conclusion: Noncompliance with repeat antibiotic dosing was associated with recommended dosing frequencies of less than 12 hours, teaching hospitals and receipt of the second dose in the ED, affecting patient mortality and critical care needs. Future studies targeting compliance improvement for antibiotics requiring frequent dosing, boarding reduction and trainee education may improve overall antibiotic compliance and clinical outcomes.