The Timing of Early Antibiotics and Hospital Mortality in Sepsis

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Abstract

Prior sepsis studies evaluating antibiotic timing have shown mixed results.

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Most cited references 22

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Hospital deaths in patients with sepsis from 2 independent cohorts.

Vincent Liu, Gabriel Escobar, John Greene … (2014)

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Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia.

Michael Bartlett, Allen Ma, Wato Nsa … (2004)

Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital. We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999. Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS). Among 13 771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%; adjusted odds ratio [AOR], 0.85; 95% confidence interval [CI], 0.74-0.98), mortality within 30 days of admission (11.6% vs 12.7%; AOR, 0.85; 95% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1% vs 45.1%; AOR, 0.90; 95% CI, 0.83-0.96). Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. Timing was not associated with readmission. Antibiotic administration within 4 hours of arrival was documented for 60.9% of all patients and for more than 50% of patients regardless of hospital characteristics. Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients.

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Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study.

Angel Arenzana, , Joan Sirvent … (2009)

Several Surviving Sepsis Campaign Guidelines recommendations are reevaluated. To analyze the effectiveness of treatments recommended in the sepsis guidelines. In a prospective observational study, we studied all adult patients with severe sepsis from 77 intensive care units. We recorded compliance with four therapeutic goals (central venous pressure 8 mm Hg or greater for persistent hypotension despite fluid resuscitation and/or lactate greater than 36 mg/dl, central venous oxygen saturation 70% or greater for persistent hypotension despite fluid resuscitation and/or lactate greater than 36 mg/dl, blood glucose greater than or equal to the lower limit of normal but less than 150 mg/dl, and inspiratory plateau pressure less than 30 cm H(2)O for mechanically ventilated patients) and four treatments (early broad-spectrum antibiotics, fluid challenge in the event of hypotension and/or lactate greater than 36 mg/dl, low-dose steroids for septic shock, drotrecogin alfa [activated] for multiorgan failure). The primary outcome measure was hospital mortality. The effectiveness of each treatment was estimated using propensity scores. Of 2,796 patients, 41.6% died before hospital discharge. Treatments associated with lower hospital mortality were early broad-spectrum antibiotic treatment (treatment within 1 hour vs. no treatment within first 6 hours of diagnosis; odds ratio, 0.67; 95% confidence interval, 0.50-0.90; P = 0.008) and drotrecogin alfa (activated) (odds ratio, 0.59; 95% confidence interval, 0.41-0.84; P = 0.004). Fluid challenge and low-dose steroids showed no benefits. In severe sepsis, early administration of broad-spectrum antibiotics in all patients and administration of drotrecogin alfa (activated) in the most severe patients reduce mortality.

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Author and article information

Journal

Title: American Journal of Respiratory and Critical Care Medicine

Abbreviated Title: Am J Respir Crit Care Med

Publisher: American Thoracic Society

ISSN (Print): 1073-449X

ISSN (Electronic): 1535-4970

Publication date Created: October 2017

Publication date (Print): October 2017

Volume: 196

Issue: 7

Pages: 856-863

Article

DOI: 10.1164/rccm.201609-1848OC

PMC ID: 5649973

PubMed ID: 28345952

SO-VID: a215b1f7-cd3e-4f9a-afed-6bca226d3c8e

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The Timing of Early Antibiotics and Hospital Mortality in Sepsis

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Abstract

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Most cited references 22

Hospital deaths in patients with sepsis from 2 independent cohorts.

Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia.

Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study.

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