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Multicenter Study
. 2022 Jan 13;26(1):19.
doi: 10.1186/s13054-021-03883-0.

Time-to-antibiotics and clinical outcomes in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study

Yunjoo Im #  1 , Danbee Kang #  2 , Ryoung-Eun Ko  3 , Yeon Joo Lee  4 , Sung Yoon Lim  4 , Sunghoon Park  5 , Soo Jin Na  3 , Chi Ryang Chung  3 , Mi Hyeon Park  6 , Dong Kyu Oh  6 , Chae-Man Lim  6 , Gee Young Suh  7   8   9 ; Korean Sepsis Alliance (KSA) investigators
Collaborators, Affiliations
Multicenter Study

Time-to-antibiotics and clinical outcomes in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study

Yunjoo Im et al. Crit Care. .

Abstract

Background: Timely administration of antibiotics is one of the most important interventions in reducing mortality in sepsis. However, administering antibiotics within a strict time threshold in all patients suspected with sepsis will require huge amount of effort and resources and may increase the risk of unintentional exposure to broad-spectrum antibiotics in patients without infection with its consequences. Thus, controversy still exists on whether clinicians should target different time-to-antibiotics thresholds for patients with sepsis versus septic shock.

Methods: This study analyzed prospectively collected data from an ongoing multicenter cohort of patients with sepsis identified in the emergency department. Adjusted odds ratios (ORs) were compared for in-hospital mortality of patients who had received antibiotics within 1 h to that of those who did not. Spline regression models were used to assess the association of time-to-antibiotics as continuous variables and increasing risk of in-hospital mortality. The differences in the association between time-to-antibiotics and in-hospital mortality were assessed according to the presence of septic shock.

Results: Overall, 3035 patients were included in the analysis. Among them, 601 (19.8%) presented with septic shock, and 774 (25.5%) died. The adjusted OR for in-hospital mortality of patients whose time-to-antibiotics was within 1 h was 0.78 (95% confidence interval [CI] 0.61-0.99; p = 0.046). The adjusted OR for in-hospital mortality was 0.66 (95% CI 0.44-0.99; p = 0.049) and statistically significant in patients with septic shock, whereas it was 0.85 (95% CI 0.64-1.15; p = 0.300) in patients with sepsis but without shock. Among patients who received antibiotics within 3 h, those with septic shock showed 35% (p = 0.042) increased risk of mortality for every 1-h delay in antibiotics, but no such trend was observed in patients without shock.

Conclusion: Timely administration of antibiotics improved outcomes in patients with septic shock; however, the association between early antibiotic administration and outcome was not as clear in patients with sepsis without shock.

Keywords: Hour-1 bundle; Mortality; Sepsis; Septic shock; Time-to-antibiotics.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study participants
Fig. 2
Fig. 2
Estimated odds ratios (ORs) for in-hospital mortality by time-to-antibiotics with 95% confidence interval (CI)s. Solid line and long dashed lines represent OR and its 95% CIs
Fig. 3
Fig. 3
a Estimated odds ratios (ORs) for in-hospital mortality by time-to-antibiotics with 95% confidence intervals (CI), confined to patients with time-to-antibiotics within 3 h. b Estimated ORs for in-hospital mortality by time-to-antibiotics with 95% CIs, confined to patients without shock and time-to-antibiotics within 3 h. c Estimated ORs for in-hospital mortality by time-to-antibiotics with 95% CIs, confined to patients with shock and time-to-antibiotics within 3 h. Solid line and long dashed lines represent OR and its 95% CIs
Fig. 4
Fig. 4
Risk-adjusted odds ratios (ORs) of in-hospital mortality by time-to-antibiotics in the prespecified subgroups for all study participants. Shown are ORs, with 95% confidence intervals, for in-hospital death for each hour of time-to-antibiotics
See this image and copyright information in PMC

References

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