For sepsis in ED, door-to-antibiotic time tied to 1-year mortality

  • Chest

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • 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.