Dr Charles Mccafferty1,2, Dr Lucy Lutze1, Sharifa Yeung1, Dr Wei-Yuen Su1
1Hornsby Ku-ring-gai Hospital, Hornsby, Australia, 2Western Sydney University, School of Medicine, Campbelltown, Australia
Biography:
Dr Charles McCafferty is a resident medical officer based at Hornsby Ku-ring-gai hospital with a PhD in infection control. He is also a conjoint lecturer for infectious diseases and microbiology at Western Sydney University. He has a keen interest in paediatric infectious diseases and microbiology, and infection prevention and control.
Abstract:
Background
Sepsis is a leading cause of mortality globally with guidelines recommending the need for timely and appropriate antimicrobial administration. The aim of this project was to evaluate the antimicrobial choice and timing of administration for patients with sepsis presenting to Hornsby Ku-ring-gai Hospital Emergency department, which has approximately 48000 presentations per year.
Methods
Data from 117 patients flagged by triage with possible sepsis who presented between July-September 2023 were analyzed. Criteria for sepsis in this study were based on the Australian Commission on Safety and Quality in Health Care Sepsis Clinical Care Standard (2022). The antimicrobial choice, dosage, and timing were reviewed, and assessed using the National Antimicrobial Prescribing Survey appropriateness definitions.
Results
Of 117 patients reviewed; twenty-one (17.9%) met sepsis criteria. Sixteen (76.2%) received antibiotics within one hour of admission. Eighteen (85.7%) had an identified source. Six (28.6%) of these patients died within six months from admission. Eleven (52.3%) did not have a weight recorded to guide dosing. Twelve (57.1%) were deemed to have appropriate choice and dosing based on their presentation, renal function, age, weight, and allergies. Nine (42.9%) were deemed to have inappropriate treatment.
Conclusion
The sepsis flagging system was surprisingly sensitive, with a positive predictive value of 17.9%. Adding patient weight values needs to be prioritised to ensure adequate dosing of agents such as gentamicin. Antimicrobial prescribing in the Emergency Department can be improved in terms of antimicrobial selection and timing of administration, with approximately 76% of patients receiving antibiotics within the golden hour.