October - 2017
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The Timing of Early Antibiotics and Hospital Mortality in Sepsis
Am J Resp Crit Care Med, 2017, 196(7);856–863
Early administration of antibiotics in sepsis and septic shock is a widely accepted measure of quality care. The exact timing thresholds remain elusive. This US, retrospective study of 35,000 adult patients with sepsis who received antibiotics within 6-hours of presentations from 21 EDs in Northern California from 2010-2013 examines this relationship.
What did they do;
What did they find;
What does it mean:
Rationale: Prior sepsis studies evaluating antibiotic timing have shown mixed results.
Objectives: To evaluate the association between antibiotic timing and mortality among patients with sepsis receiving antibiotics within 6 hours of emergency department registration.
Methods: Retrospective study of 35,000 randomly selected inpatients with sepsis treated at 21 emergency departments between 2010 and 2013 in Northern California. The primary exposure was antibiotics given within 6 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.
Measurements and Main Results: The median time to antibiotic administration was 2.1 hours (interquartile range, 1.4–3.1 h). The adjusted odds ratio for hospital mortality based on each hour of delay in antibiotics after registration was 1.09 (95% confidence interval [CI], 1.05–1.13) for each elapsed hour between registration and antibiotic administration. The increase in absolute mortality associated with an hour’s 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)
Conclusions: In a large, contemporary, and multicenter sample of patients with sepsis in the emergency department, hourly delays in antibiotic administration were associated with increased odds of hospital mortality even among patients who received antibiotics within 6 hours. The odds increased within each sepsis severity strata, and the increased odds of mortality were greatest in septic shock.
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