From the Journals

Septic shock patients suffer most from delayed antibiotics



Hospital mortality for sepsis patients was 9% more likely with each hour of delayed administration of antibiotics, and the mortality rates increased with the severity of sepsis, based on data from 35,000 randomly selected sepsis patients.

Early administration of antibiotics in sepsis cases has become accepted as a way to improve outcomes, but the benefits have not been well studied, wrote Vincent X Liu, MD, MS, of Kaiser Permanente Division of Research, Oakland, Calif., and his colleagues.

To quantify the impact of antibiotic timing on mortality rates in different types of sepsis patients, the researchers reviewed data from 35,000 adults treated for sepsis at 21 emergency departments in northern California between 2010 and 2013. The time from registration at the emergency department to administration of the first antibiotics was less than 6 hours (Am J Respir Crit Care Med. 2017 March 27. doi: 10.1164/rccm.201609-1848OC).

The overall mortality rates were 3.9%, 8.8%, and 26.0% for sepsis, severe sepsis, and septic shock, respectively. Absolute mortality increased by 0.3% for sepsis, 0.4% for severe sepsis, and 1.8% for septic shock patients after an hour’s delay in the administration of antibiotics, and the adjusted odds ratio for hospital mortality was 1.09 for each hour between patient registration and antibiotic administration. The median time to the first administration of antibiotics was 2.1 hours, ranging from 1.7 hours for septic shock patients to 2.3 hours for sepsis patients, with ceftriaxone having been the most commonly used antibiotic across all groups.

Approximately 42% of patients received one antibiotic and 43% received two antibiotics. The odds of receiving two or more antibiotics were significantly higher for septic shock patients compared with sepsis patients (72% vs. 52%, respectively).

The findings were limited by several factors, including the inability to adjust for concomitant sepsis treatments and preexisting antibiotic treatments, the researchers said.

The study results do not resolve all questions about the timing of antibiotic administration for sepsis patients, such as whether there is additional benefit to giving the medications at 2 hours rather than 3 hours or 4 hours after ED admission, the researchers noted. However, “our findings support currently held beliefs that administering early antibiotics to infected patients with systemic inflammation is beneficial for reducing mortality,” they said.

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