In this episode, I’ll discuss an abstract by a pharmacy resident about the use of a combination antibiotic bag (CAB) in severe sepsis and septic shock.

At the NYSCHP annual assembly, I saw a presentation about a novel way to increase compliance with the sepsis core measure bundle of antibiotics and 30 ml/kg of crystalloid fluids for septic shock.

The primary author of this investigation is Michael Lorenzo, and he agreed to join me on the podcast to discuss his intervention. Pharmacy Mike is a Doctor of Pharmacy and PGY-1 resident at Upstate University Hospital in Syracuse, NY.

Below is a summary of his abstract – listen to the episode to hear the full interview!

Title

Impact of a Combination Antibiotic Bag on Compliance with Surviving Sepsis Campaign Goals in Emergency Department Patients with Severe Sepsis and Septic Shock

Authors

Lorenzo M, MacConaghy L, Meola G, Miller C, Pratt B, Steele J, Probst L, Seabury R

Purpose

The authors sought to determine whether the use of a combination antibiotic bag (CAB) of 2 grams cefepime plus 1 gram vancomycin mixed in 1 liter of normal saline impacts compliance with quality measures related to antibiotics and fluids within 3 hours of presentation for patients with severe sepsis or septic shock.

Methods

This was a retrospective chart review in the ED of a single academic medical center. Patients receiving > 1 antibiotic were included if they met criteria for severe sepsis or septic shock.

The primary endpoint was the administration of two antibiotics and a 30 mL/kg crystalloid challenge within three hours of ED triage. The secondary endpoint was 14-day in-hospital mortality.

Results

80 patients in the CAB group and 80 patients in the non-CAB group were included in this analysis. The CAB group met the primary outcome more frequently than the non-CAB group (63.8% vs. 22.5%). No difference in 14-day in-hospital mortality was noted although the CAB group trended towards a lower mortality rate compared to the non-CAB group (25% vs. 32.5%). The median time to administration of two antibiotics and the median time to administration of a 30 mL/kg crystalloid challenge were also shorter in the CAB group.

Conclusion

The authors concluded:

The CAB improved the proportion achieving guideline recommendations for crystalloid and antibiotic administration in a cohort of ED patients with severe sepsis or septic shock. Such an intervention has not been previously reported and could play a meaningful role in the management of severe sepsis and septic shock.

Discussion

Listen to the episode for a discussion of the study limitations and author’s next steps.

References discussed:

1 gram initial dose of vancomycin & impact on outcome

Vancomycin AUC:MIC estimator

CAB stability data: Vance VH. Stability of cefepime admixed with vancomycin, metronidazole, ampicillin, clindamycin, tobramycin, netilmicin, TPN solution, and PD solution. Syracuse, NY: Bristol-Myers Company; 1992 Oct 14

Starting Thursday, May 4, 2017, members of my Critical Care Pharmacy Academy will have access to my new Masterclass: ICU Sedation. To learn more about the Academy and join, go to pharmacyjoe.com/academy.

If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.

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