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. 2017 Jul;48(1):29-35.
doi: 10.1097/SHK.0000000000000833.

Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis

Moonjoo Han  1 , Julie C Fitzgerald, Fran Balamuth, Luke Keele, Elizabeth R Alpern, Jane Lavelle, Marianne Chilutti, Robert W Grundmeier, Vinay M Nadkarni, Neal J Thomas, Scott L Weiss
Affiliations

Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis

Moonjoo Han et al. Shock. 2017 Jul.

Abstract

Objective: Delayed antimicrobial therapy in sepsis is associated with increased hospital mortality, but the impact of antimicrobial timing on long-term outcomes is unknown. We tested the hypothesis that hourly delays to antimicrobial therapy are associated with 1-year mortality in pediatric severe sepsis.

Design: Retrospective observational study.

Setting: Quaternary academic pediatric intensive care unit (PICU) from February 1, 2012 to June 30, 2013.

Patients: One hundred sixty patients aged ≤21 years treated for severe sepsis.

Interventions: None.

Measurements and main results: We tested the association of hourly delays from sepsis recognition to antimicrobial administration with 1-year mortality using multivariable Cox and logistic regression. Overall 1-year mortality was 24% (39 patients), of whom 46% died after index PICU discharge. Median time from sepsis recognition to antimicrobial therapy was 137 min (IQR 65-287). After adjusting for severity of illness and comorbid conditions, hourly delays up to 3 h were not associated with 1-year mortality. However, increased 1-year mortality was evident in patients who received antimicrobials ≤1 h (aOR 3.8, 95% CI 1.2, 11.7) or >3 h (aOR 3.5, 95% CI 1.3, 9.8) compared with patients who received antimicrobials within 1 to 3 h from sepsis recognition. For the subset of patients who survived index PICU admission, antimicrobial therapy ≤1 h was also associated with increased 1-year mortality (aOR 5.5, 95% CI 1.1, 27.4), while antimicrobial therapy >3 h was not associated with 1-year mortality (aOR 2.2, 95% CI 0.5, 11.0).

Conclusions: Hourly delays to antimicrobial therapy, up to 3 h, were not associated with 1-year mortality in pediatric severe sepsis in this study. The finding that antimicrobial therapy ≤1 h from sepsis recognition was associated with increased 1-year mortality should be regarded as hypothesis-generating for future studies.

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Figures

Figure 1
Figure 1
Survival analysis for time to initial antimicrobial therapy at 3 hour cutoff point Kaplan-Meier survival analysis comparing initial antimicrobial therapy at the 3 hour cutoff point from severe sepsis recognition. Total patients n=160. Log-rank test, p=0.03.
Figure 2
Figure 2
Survival analysis for time to initial antimicrobial therapy at trichotomous cutoff points. Kaplan-Meier survival analysis comparing initial antimicrobial therapy at trichotomous cutoff points from severe sepsis recognition. Total patients n=160. Log-rank test p=0.008. Inset shows PICU survivors only, n=139. Log-rank test=0.06.
See this image and copyright information in PMC

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