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Randomized Controlled Trial
. 2011 Sep;39(9):2066-71.
doi: 10.1097/CCM.0b013e31821e87ab.

Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol

Michael A Puskarich  1 , Stephen Trzeciak, Nathan I Shapiro, Ryan C Arnold, James M Horton, Jonathan R Studnek, Jeffrey A Kline, Alan E Jones; Emergency Medicine Shock Research Network (EMSHOCKNET)
Affiliations
Randomized Controlled Trial

Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol

Michael A Puskarich et al. Crit Care Med. 2011 Sep.

Abstract

Objective: We sought to determine the association between time to initial antibiotics and mortality of patients with septic shock treated with an emergency department-based early resuscitation protocol.

Design: Preplanned analysis of a multicenter randomized controlled trial of early sepsis resuscitation.

Setting: Three urban U.S. emergency departments.

Patients: Adult patients with septic shock.

Interventions: A quantitative resuscitation protocol in the emergency department targeting three physiological variables: central venous pressure, mean arterial pressure, and either central venous oxygen saturation or lactate clearance. The study protocol was continued until all end points were achieved or a maximum of 6 hrs.

Measurements and main results: Data on patients who received an initial dose of antibiotics after presentation to the emergency department were categorized based on both time from triage and time from shock recognition to initiation of antibiotics. The primary outcome was inhospital mortality. Of 291 included patients, mortality did not change with hourly delays in antibiotic administration up to 6 hrs after triage: 1 hr (odds ratio [OR], 1.2; 0.6-2.5), 2 hrs (OR, 0.71; 0.4-1.3), 3 hrs (OR, 0.59; 0.3-1.3). Mortality was significantly increased in patients who received initial antibiotics after shock recognition (n = 172 [59%]) compared with before shock recognition (OR, 2.4; 1.1-4.5); however, among patients who received antibiotics after shock recognition, mortality did not change with hourly delays in antibiotic administration.

Conclusion: In this large, prospective study of emergency department patients with septic shock, we found no increase in mortality with each hour delay to administration of antibiotics after triage. However, delay in antibiotics until after shock recognition was associated with increased mortality.

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Conflict of interest statement

The remaining authors have not disclosed any potential conflicts of interest.

Figures

Figure 1
Figure 1
Graphical depiction of the time from triage to initial antibiotics in the entire cohort, stratified by final hospital outcome. Grey bars represent patients who survived the hospitalization and black bars represent patients who died in the hospital.
Figure 2
Figure 2
Graphical depiction of the time from shock recognition to initial antibiotics in the entire cohort, stratified by final hospital outcome. Shock recognition is indicated by Time 0. Subjects with negative times received antibiotics before shock recognition. Grey bars represent patients who survived the hospitalization and black bars represent patients who died in the hospital.
See this image and copyright information in PMC

Comment in

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