Positive impact of an emergency department protocol on time to antimicrobial administration in dogs with septic peritonitis.

Abstract

OBJECTIVE: To determine whether the development of a specific antimicrobial protocol for the treatment of canine intra-abdominal sepsis would improve time to appropriate antimicrobial administration following diagnosis of bacterial peritonitis. DESIGN: Case controlled observational study. SETTING: A tertiary referral small animal teaching hospital. ANIMALS: Twenty dogs undergoing surgery for septic peritonitis prior to the deployment of the abdominal sepsis protocol served as a case control population and 40 dogs identified as having septic peritonitis after deployment of the protocol served as the study population. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Median time from diagnosis of septic peritonitis to antimicrobial administration was 6 hours (range 1-10 h) in the preprotocol group (PRE), and 1 hour (range 1-2 h) in the postprotocol group (POST) (P = 0.001). Five of 20 (25%) culture and sensitivity results yielded negative cultures in the PRE versus 6 of 34 (17.6%) in the POST. Inappropriate empirical antimicrobials were selected 3 of 20 times (15%) in the PRE and 3 of 34 times (8.8%) in the POST. The overall survival to discharge was 60% in the PRE and 70% in the POST (P = 0.425). CONCLUSIONS: The development of an emergency department antimicrobial protocol significantly decreased time to antimicrobial administration following identification of septic peritonitis in dogs.