The Timing of Early Antibiotics and Hospital Mortality in Sepsis.

Abstract

Prior sepsis studies evaluating antibiotic timing have shown mixed results.To evaluate the association between antibiotic timing and mortality among sepsis patients receiving antibiotics within 6 hours of emergency department registration.Retrospective study of 35,000 randomly selected sepsis inpatients treated at 21 emergency departments between 2010 and 2013 in Northern California. The primary exposure was antibiotics given within six hours of emergency department registration. The primary outcome was adjusted in-hospital mortality. We used detailed physiologic data to quantify severity of illness within 1 hour of registration and logistic regression to estimate the odds of hospital mortality based on antibiotic timing and patient factors.The median time to antibiotic administration was 2.1 hours (interquartile range: 1.4-3.1 hours). The adjusted odds ratio for hospital mortality based on each hour of delay in antibiotics after registration was 1.09 (95% CI, 1.05-1.13) for each elapsed hour between registration and antibiotic administration. The increase in absolute mortality associated with an hours delay in antibiotic administration was: 0.3% (95% CI, 0.01%-0.6%; p=0.04) for sepsis; 0.4% (95% CI, 0.1%-0.8%; p=0.02) for severe sepsis; and 1.8% (95% CI, 0.8%-3.0%; p=0.001) for shock.In a large, contemporary, and multicenter sample of sepsis patients in the emergency department, hourly delays in antibiotic administration were associated with increased odds of hospital mortality even among patients all of whom received antibiotics within 6 hours. The odds increased within each sepsis severity strata and the increased odds of mortality were greatest in septic shock.

View details for DOI 10.1164/rccm.201609-1848OC

View details for PubMedID 28345952