Purpose: The primary objective was to compare administration times of intravenous push (IVP) compared to piggyback (IVPB) antibiotics in the emergency department (ED) in patients with sepsis and septic shock.
Methods: This retrospective, single-center, IRB-exempt, chart review conducted at Jefferson Einstein Philadelphia Hospital (JEPH) included ED patients with sepsis or septic shock who received
either IVP or IVPB ceftriaxone or daptomycin. Patients with sepsis were identified by ICD-10 code and sepsis alert, and septic shock patients had vasopressor requirements. Patients were excluded if transferred from outside hospital. To account for institution-wide process changes due to drug shortages, IVPB antibiotics were evaluated from January 1, 2024 to September 30, 2024, and IVP antibiotics were evaluated from November 1, 2024 to July 31, 2025.
Results: Patients assessed for eligibility included 76 patients in the IVP group and 51 patients in the IVPB group. No patients who were administered daptomycin met inclusion criteria
. There was no difference in median time to administration between the two groups (IVPB 40.8 min vs IVP 39.2 min. p=0.99). In patients with sepsis, 34/46 patients (73.9%) and 51/72 patients (70.8%) in the IVPB and IVP group received antibiotics within 3 hours, respectively. In patients with septic shock, 1/5 patients (20%) and 2/4 patients (50%) in the IVPB and IVP group received doses within one hour, respectively.
Similar rates of in-hospital mortality were seen in septic shock patients, and no patients experienced a type-1 hypersensitivity reaction.
Conclusion: Results showed no difference in administration times between IVP and IVPB ceftriaxone. Post-intervention IVP times to administration in prior studies were comparable to pre-intervention IVPB times to administration at JEPH. Future research should aim to evaluate potential factors that may contribute to delays in time to administration of antibiotics in sepsis and septic shock.
