- This institution concluded that getting septic patients antibiotics within an hour was inadvisable because of:
- Risk of encouraging inappropriate antibiotic use.
- Diverting resources to patients with vague presentation or stable vitals.
Why this matters
- Antibiotic delay, post- vs preintervention:
- 3-hour delay: 21% vs 30% (change, −9%; 95% CI, −16% to −2%).
- 1-hour delay: 71% vs 85% (change, −14%; 95% CI, −20% to −8%).
- Factors associated with delay:
- Vague presenting symptoms.
- Triage to nonacute areas.
- Presenting preintervention.
- Lower Sequential Organ Failure Assessment score.
- Subgroup who got antibiotics within 1 hour presented with overt hypotension and explicit symptoms.
- Authors: "It is our opinion that currently the 2018 SSC recommendations about antibiotic timing are unjustifiable."
- 2-year retrospective before-and-after cohort study of consecutive adults presenting to the emergency department (ED) with septic shock (N=654).
- Halfway through, the ED introduced a sepsis quality improvement intervention.
- Outcomes: delayed antibiotics (>3 hours and >1 hour).
- MIT-MGH Strategic Partnership.
- CRICO Risk Management Foundation.
- Nihon Kohden Corporation.
- National Foundation of Emergency Medicine.
- Single-center study.