Impact of the timeliness of antibiotic therapy on the outcome of patients with sepsis and septic shock

Abstract

Objectives: To review the impact of the timeliness of antibiotic therapy on the outcome of patients with sepsis or septic shock. Methods: We searched MEDLINE, EMBASE, the Cochrane Library, Web of Science, Open-SIGLE databases, ClinicalTrials.gov and the metaRegister of Controlled Trials on July 27, 2020 for relevant studies on the timing of antibiotic therapy in adult patients with sepsis or septic shock. The primary outcome measure was all-cause crude or adjusted mortality at reported time points. Results: We included 35 sepsis studies involving 154,330 patients. Nineteen studies (54%) provided information on the appropriateness of antibiotic therapy in 20,062 patients of whom 16,652 patients (83%) received appropriate antibiotics. Twenty-four studies (68.6%) reported an association between time-toantibiotics and mortality. Time thresholds associated with patient's outcome varied considerably between studies consisting of a wide range of time cutoffs (1 h, 125 min, 3 h or 6 h) in 14 studies, hourly delays (derived from the analyses of time intervals ranging from to 1 to 24 h) in 8 studies or time-to-antibiotic in 2 studies. Analyses of subsets of studies that focused on patients with septic shock (11 studies, 12,756 patients) or with sepsis (6 studies, 24,281 patients) yielded similar results. Conclusions: While two-thirds of sepsis studies reported an association between early administration of antibiotic therapy and patient outcome, the time-to-antibitiocs metrics varied significantly across studies and no robust time thresholds emerged.

Vaccination to Prevent Pseudomonas aeruginosa Bloodstream Infections

“…Rapid empirical administration of antibiotics has long been a cornerstone of sepsis management ( Kang et al, 2003 ; Micek et al, 2005 ; Lodise et al, 2007 ). However, there is some controversy over whether early administration of antibiotics improves patient outcomes ( Asner et al, 2021 ). Empirical treatment can result in a sub-therapeutic dose or incorrect antibiotic choice.…”

Impact of sepsis education for healthcare professionals and students on learning and patient outcomes: a systematic review

“…In particular, obtaining blood cultures and administration of appropriate antimicrobial agents are cornerstones of sepsis management [14]. Timely and appropriately administered antimicrobial treatments from the time where patients display signs of organ dysfunction in the context of suspected or confirmed infection are significantly associated with improved patient survival [15][16][17]. Studies have shown that delayed administration of J o u r n a l P r e -p r o o f antimicrobials leads to increased mortality, risk of complications during treatment and length of hospitalisation, resulting in higher medical costs [18,19].…”

Pulsed Electromagnetic Field (PEMF) Treatment Reduces Lipopolysaccharide-Induced Septic Shock in Mice

“…In addition, the criteria for selecting an antibiotic depend on the site of infection and/or the organs affected [ 20 ]. Consequently, the mortality sharply increases as the initial response time is delayed [ 21 ]. For these reasons, the development of new methods for sepsis diagnosis and alternative therapies to control systemic inflammatory reactions is an intense research focus.…”