Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour

Abstract

The results of the analysis of this large population of patients with severe sepsis and septic shock demonstrate that delay in first antibiotic administration was associated with increased in-hospital mortality. In addition, there was a linear increase in the risk of mortality for each hour delay in antibiotic administration. These results underscore the importance of early identification and treatment of septic patients in the hospital setting.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…In the presence of sepsis or septic shock, each hour delay in administration of appropriate antimicrobials is associated with a measurable increase in mortality [57,74]. Further, several studies show an adverse effect on secondary end points (e.g., LOS [75], acute kidney injury [76], acute lung injury [77], and organ injury assessed by Sepsis-Related Organ Assessment score [78] with increasing delays.…”

“…Further, several studies show an adverse effect on secondary end points (e.g., LOS [75], acute kidney injury [76], acute lung injury [77], and organ injury assessed by Sepsis-Related Organ Assessment score [78] with increasing delays. Despite a meta-analysis of mostly poor-quality studies that failed to demonstrate a benefit of rapid antimicrobial therapy, the largest and highest-quality studies support giving appropriate antimicrobials as soon as possible in patients with sepsis with or without septic shock [57,74,[79][80][81]. The majority of studies within the meta-analysis were of low quality due to a number of deficiencies, including small study size, using an initial index time of an arbitrary time point such as emergency department arrival, and indexing of outcome to delay in time to the first antimicrobial (regardless of activity against the putative pathogen) [82,83].…”

Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department

“…The prevalence of patients with sepsis and severe sepsis or septic shock presenting at the ED was observed in 2.1 to 6.3% and 0.6 to 0.9%, respectively [2]. Patients with early sepsis and evolving severe sepsis or septic shock should already be identified at first presentation because delay in antibiotic administration is associated with increased in-hospital mortality, whereas early goal-directed therapy for the treatment of severe sepsis and septic shock initiated in the ED may reduce mortality [3,4].…”

Is it time to implement door-to-needle time for “infection attacks”?

“…A substantial body of observational studies has shown that delay in the time to receipt of antibiotics is associated with adverse outcome among patients with severe sepsis and septic shock [3,4]. While guidelines recommend that antibiotics be administered within 1 h, it must be recognized that this has not been proven in a randomized trial and that controversy still exists as to what may define a clinically significant delay or threshold for antibiotic initiation [5,6].…”