Antibiotic Timing and Outcomes in Sepsis

Area of Science:

• Critical Care Medicine
• Emergency Medicine
• Infectious Diseases

Background:

• Sepsis and septic shock are life-threatening conditions requiring prompt medical intervention.
• The emergency department (ED) is the initial point of care for many sepsis patients.
• Optimizing care processes within the ED is critical for improving patient outcomes.

Purpose of the Study:

• To evaluate the impact of emergency department (ED) time and care processes on mortality and hospital length of stay (LOS) in patients with sepsis or septic shock.
• To determine the association between time to antibiotic administration and patient outcomes.
• To identify critical time intervals in sepsis management within the ED.

Main Methods:

• An observational cohort study of 117 patients admitted to the intensive care unit (ICU) from the University of Louisville Hospital ED.
• Key variables included time from triage to ICU transport, antibiotic order, and antibiotic administration.
• In-hospital mortality and hospital LOS were primary and secondary outcomes, respectively.

Main Results:

• No significant association was found between overall ED time and mortality.
• Each hour delay in ordering antibiotics increased mortality risk by 22%; each hour delay in administration increased risk by 15%.
• Delays in both ordering and administering antibiotics were independently associated with increased hospital LOS.

Conclusions:

• While overall ED time was not linked to mortality, delays in antibiotic order and administration significantly increase mortality risk in septic patients.
• Delayed antibiotic care also leads to longer hospital stays, both overall and within the ICU.
• Prompt initiation of antibiotics is a critical factor in improving sepsis outcomes.