Cefepime Intravenous Push Versus Intravenous Piggyback on Time to Administration of First-Dose Vancomycin in the Emergency Department

Abstract

Study Objective: The combination of cefepime and vancomycin is commonly used as an empiric antimicrobial regimen. Time to first-dose antibiotics is associated with survival benefit. The objective of this study is to evaluate whether cefepime intravenous push (IVP) is associated with a shorter time to vancomycin administration in the emergency department (ED) compared with cefepime intravenous piggyback (IVPB) infusion. Methods: This was a retrospective chart review of records of patients who were treated with the vancomycin–cefepime combination in the ED. Results: A total of 1071 charts from April 2013 to January 2015 were reviewed. Included in the pre-(IVBP) group was 536 subjects and 535 subjects in the post-(IVP) group. The indications for antibiotic therapy were sepsis alone (28.3%), pneumonia alone (30.7%), sepsis with pneumonia (36.5%), and other (4.6%). The median time from administration of cefepime to vancomycin were 63.5 minutes and 2.0 minutes in the IVPB and IVP cohorts, respectively ( P < .001). Conclusion: The use of first-dose cefepime IVP in the ED resulted in a statistically significant decrease in time to vancomycin administration of over 1 hour.