- For patients presenting to the emergency department (ED) with clinical evidence of sepsis, delays in antibiotic treatment correlate with higher 1-year mortality.
- Authors: “Decreasing average door-to-antibiotic time to 1.5 hours could prevent…over 4 deaths per month just in the EDs included in this study.”
- Trials needed.
Why this matters
- Evidence is mixed as to whether antibiotic timing affects sepsis outcomes.
- Previous studies often examined hospital mortality and may have missed nonlinear relationships.
- For each additional hour of door-to-antibiotic time, adjusted 1-year mortality odds rose by 10% (95% CI, 5%-14%; absolute increase, 1.1% [95% CI, 0.7%-1.6%]).
- Similar results upon propensity-matched analysis.
- Association remained after exclusion of in-hospital, 7-day, and 30-day deaths.
- Retrospective cohort study of adults presenting to 4 EDs with clinical sepsis (n=10,811).
- Adjusting for multiple confounders, authors assessed relationship between door-to-antibiotic time and 1-year mortality.
- Funding: Intermountain Research and Medical Foundation; University of Utah; NIH.
- Unknown if efforts to speed antibiotics wind up leading to overtreatment and adverse outcomes.
- Clinical rather than confirmed sepsis was inclusion criterion.
- Possible residual confounders.
- Mechanism of association not established.