{
  "abstract": "Background and Importance Sepsis is a life-threatening condition with high morbidity and mortality. Prompt initiation of adequate antibiotic therapy is crucial, as delays beyond the first hour increase mortality. In 2018, a sepsis code protocol was implemented in Madrid to standardise early detection and treatment of sepsis.Aim and Objectives Primary objective: to analyse the percentage of patients receiving antimicrobial therapy within the first hour of sepsis code activation.Secondary objective: to analyse the association between antibiotic prescription, validation, and administration times after sepsis code activation, and their impact on mortality, ICU admission/stay, and hospital stay.Material and Methods A retrospective, single-centre, observational study was conducted in a tertiary hospital between February and April 2025. All patients with sepsis code activation were included. Variables collected: demographics, clinical outcomes (ICU admission, mortality, length of stay), and pharmacotherapy (prescription, validation, administration and sepsis code activation times). Times to administration, prescription and validation were measured from sepsis code activation and defined as early if < 1 hour had passed. Statistical analysis included descriptive statistics (median, interquartile range-IQR) and association tests (odds ratios-OR, Wilcoxon test, Spearman test).Results A total of 270 sepsis codes were included for analysis, corresponding to 261 patients (median age 70 years, 59% male). ICU admission occurred in 51.5% of cases, with an overall mortality of 19.5%. Median hospital stay was 8 days (IQR 5–18).Regarding antibiotic therapy:– Administration time: median 61.8 minutes (IQR –25 to +233). Early administration: 12.36%.– Prescription time: median 2.1 minutes (IQR –78.8 to +58.2). Early prescription: 19,35%.– Validation time: median 74 minutes (IQR –17 to +222). Early validation: 11.64%.5.96% of patients received both prescription and administration within the first hour after activation, and 2.1% also had pharmacist validation. Early antibiotic administration was associated with reduced hospital stay (rho=0.243; p<0.01), lower ICU admission (OR 2.9; p<0.01), and lower ICU length of stay (rho=0.247, p<0.01), although not with mortality.Conclusion and Relevance Antibiotic administration within the first hour after sepsis code activation is associated with reduced hospital stay and lower ICU admission/stay. However, adherence to the complete sequence (prescription–validation–administration <1 hour) remains very low. Strengthening the involvement of hospital pharmacists in validation and protocol adherence could optimise antimicrobial stewardship and improve patient outcomes.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesus, Pharmacy Service, Madrid, Spain"
      ],
      "name": "L Fernández Romero"
    },
    {
      "affiliations": [
        "Hospital General Universitario Gregorio Marañón, Pharmacy Service, Madrid, Spain"
      ],
      "name": "B Torroba Sanz"
    },
    {
      "affiliations": [
        "Hospital General Universitario Gregorio Marañón, Pharmacy Service, Madrid, Spain"
      ],
      "name": "JM Montes Gómez"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesus, Pharmacy Service, Madrid, Spain"
      ],
      "name": "B Leal Pino"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesus, Pharmacy Service, Madrid, Spain"
      ],
      "name": "M Echávarri De Miguel"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesus, Pharmacy Service, Madrid, Spain"
      ],
      "name": "B Riva De La Hoz"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesus, Pharmacy Service, Madrid, Spain"
      ],
      "name": "A Abril Cabero"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesus, Pharmacy Service, Madrid, Spain"
      ],
      "name": "E Algarra Sánchez"
    },
    {
      "affiliations": [
        "Hospital Infantil Universitario Niño Jesus, Pharmacy Service, Madrid, Spain"
      ],
      "name": "E Nieto Mártil"
    },
    {
      "affiliations": [
        "Hospital General Universitario Gregorio Marañón, Pharmacy Service, Madrid, Spain"
      ],
      "name": "A Herranz Alonso"
    },
    {
      "affiliations": [
        "Hospital General Universitario Gregorio Marañón, Pharmacy Service, Madrid, Spain"
      ],
      "name": "M Sanjurjo Saez"
    }
  ],
  "title": "4CPS-126 Against the clock: impact of antibiotic administration, prescription and validation times on outcomes in the sepsis code",
  "uid": "c8dd8f0d-c2d8-513c-af05-392346a2dbc2"
}