PSHP 2026 Residency Conference

Purpose
To evaluate the compliance rate of administering the first dose of antibiotic within 60 minutes to neonates diagnosed with late-onset sepsis following the implementation of interdisciplinary education and electronic order set modifications. 
 
Methods
This was a retrospective, single center, observational study utilizing a pre- and post-intervention cohort of patients 72 hours old to 180 days old. Study timeframes for the pre- and post-interventional cohort were June 1, 2023 to December 31, 2023 and June 1, 2025 to December 31, 2025. The primary outcome of time to administration is a composite of the time from ordering to verification, verification to final preparation check, and final preparation check to administration. Antibiotics were not assessed for time to administration if they were not the very first antibiotic given for a new infection or an agent used to broaden antibiotic coverage. Antibiotic orders that did not broaden coverage were excluded if an antibiotic was given within the last 72 hours and all orders for treatment of early-onset sepsis were excluded. Secondary outcomes reviewed all-cause 14-day and 30-day mortality and presence of high-risk comorbidities.  
 
Results 
The primary outcome of time to antibiotic administration from order placement was statistically significant for being shorter in the post-cohort with a median difference of 12.5 minutes (p < 0.001) and 47.7% of patients in the post-cohort had antimicrobials within 60 minutes as compared to 23.9% of patients in the pre-cohort (p = 0.007). Furthermore, every component of the composite primary outcome was statistically significant for being shorter in the post-cohort (p < 0.001). The secondary outcomes of the number of patients with late-onset sepsis risk factors (p = 0.804), 14-day mortality (p = 0.244), and 30-day mortality (p = 0.818) were not statistically different between cohorts.  
 
Conclusion
A greater percentage of patients received antibiotics within 60 minutes, which suggests that the interventions made by Pennsylvania Hospital made a clinical difference. The secondary outcome data suggests that neonates in both the pre- and post-cohort had comparable risk factors for developing late-onset neonatal sepsis. There was no statistical difference in mortality between the cohorts.