Emergence of Carbapenem‐ResistantHafnia:The Fall of the Last Soldier

these results were confirmed by the Center for Disease Control and Prevention’s RTPCR for pandemic (H1N1) 2009. This study was approved by the institutional review board of Rush University Medical Center. There were 32 hospitalized patients, of which 16 were admitted to the intensive care unit (ICU). The most common diagnosis at hospital admission was pneumonia. Twenty-two (69%) of 32 patients received oseltamivir (44% of non-ICU vs 94% of ICU patients; ). The meP p .002 dian duration of symptoms prior to hospitalization was 3 days (range, 1–7 days). The median duration from hospitalization to the administration of oseltamivir was 27.3 h (range, 3.1–222.5 h). Among patients treated with oseltamivir, the median duration from the time the drug was ordered to the time it was administered was 3.5 h (range, 1.2–17.7 h). Ten (46%) of 22 patients had a delay of 4 h from the time oseltamivir was ordered to the time of administration. Empiric treatment for pandemic (H1N1) 2009 influenza is currently recommended for all hospitalized patients with suspected or proven influenza [1]. Recent observations suggest a mortality benefit of antiviral treatment for hospitalized patients with 2009 (H1N1) influenza and recommend that treatment be initiated as early as possible in hospitalized patients [2, 3]. We observed a significant delay (median, 27.3 h) in the initiation of oseltamivir treatment among hospitalized patients. This may be attributable to delays in diagnosis or turnaround of RTPCR results (batched and performed daily at our institution). More significant is that despite the use of an electronic medication order system, almost one-half of patients treated with oseltamivir experienced a delay of 4 h before receiving the drug. This may be attributable to the fact that orders for oral antivirals are not viewed with the same urgency as intravenous antibiotics, which can be ordered “stat.” The early administration of antibiotics has been demonstrated to have mortality benefit and is widely viewed as an important performance indicator [4]. The rapid initiation of antiviral therapy for influenza treatment should probably be viewed with similar importance [5]. The results of our study should encourage physicians, nurses, and pharmacists to examine closely all barriers to timely antiviral prescribing and administration.