Abstract
Background
Current sepsis guidelines recommend administration of antibiotics within 1 hour of
emergency department (ED) triage. However, the quality of the supporting evidence
is moderate, and studies have shown mixed results regarding the association between
antibiotic administration timing and outcomes in septic shock. We investigated to
evaluate the association between antibiotic administration timing and in-hospital
mortality in septic shock patients in the ED, using propensity score analysis.
Methods
An observational study using a prospective, multicenter registry of septic shock,
comprising data collected from 10 EDs, was conducted. Septic shock patients were included,
and patients were divided into 4 groups by the interval from triage to first antibiotic
administration: group 1 (≤1 hour; reference), 2 (1-2 hours), 3 (2-3 hours), and 4
(>3 hours). The primary endpoint was in-hospital mortality. After inverse probability
of treatment weighting, the outcomes of the groups were compared.
Results
A total of 2250 septic shock patients were included, and the median time to first
antibiotic administration was 2.29 hours. The in-hospital mortality of groups 2 and
4 were significantly higher than those of group 1 (odds ratio [OR] 1.248; 95% confidence
interval [CI], 1.053-1.478; P = .011; OR 1.419; 95% CI, 1.203-1.675; P < .001, respectively), but those of group 3 was not (OR 1.186; 95% CI, 0.999-1.408;
P = .052). Subgroup analyses of patients (n = 2043) with appropriate antibiotics presented
similar results.
Conclusions
In patients with septic shock, rapid administration of antibiotics was generally associated
with a decrease in in-hospital mortality, but no “every hour delay” was seen.
Keywords
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Article info
Publication history
Published online: October 14, 2019
Footnotes
Conflict of Interest: The authors declare that they have no conflicts o interest.
Authorship: All authors had access to the data and a role in writing the manuscript. WY Kim and THL conceived the idea. BSK, WY Kim, SPC and KSK wrote the manuscript. GHK and GJS coordinated the study. BSK, KSK, SHC, TGS, YHJ, SMR, WY Kwon, KSH, TGS, SPC, HSC, YSP, THL, and WY Kim collected data. GHK, HK, and GJS did analysis of data. YHJ, HK, and YJK performed statistical analysis. THL and GJS supervised whole study process. WY Kwon and KSH assisted with study design and revised the manuscript. All authors read and approved the final manuscript.
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