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Adequacy of probabilistic prehospital antibiotic therapy for septic shock

Romain Jouffroy1, Basile Gilbert2, Anna Hassan3

  • 1Intensive Care Unit, University Hospital Ambroise Paré, Boulogne Billancourt, France; Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France; Centre de recherche en Epidémiologie et Santé des Populations, U1018 INSERM, Université Paris Saclay, France; Institut de Recherche bioMédicale et d'Epidémiologie du Sport - EA7329, INSEP, Université de Paris, France; EA 7525 Université des Antilles, France.

The American Journal of Emergency Medicine
|January 7, 2022
PubMed

Insights

Early antibiotic therapy (ABT) in prehospital settings for septic shock (SS) is crucial. This study found that adequate prehospital ABT is frequently administered and significantly reduces 30-day mortality in SS patients.

Area of Science:

  • Emergency Medicine
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Sepsis management guidelines emphasize early recognition, diagnosis, and treatment, including prompt antibiotic therapy (ABT), to reduce septic shock (SS) mortality.
  • The effectiveness and adequacy of probabilistic prehospital ABT in critically ill patients remain under-investigated.

Purpose of the Study:

  • To evaluate the adequacy of probabilistic prehospital antibiotic therapy (ABT) in patients with septic shock (SS).
  • To determine the association between prehospital ABT administration and 30-day mortality in SS patients managed by a mobile intensive care unit (mICU).

Main Methods:

  • Retrospective analysis of consecutive patients with SS treated by a prehospital mICU intervention from May 2016 to March 2021.
  • Assessment of prehospital ABT adequacy, including administered antibiotic class and timing.
  • Statistical analysis using propensity score matching and inverse probability treatment weighting to evaluate the impact on 30-day mortality.

Main Results:

  • Among 386 SS patients, 119 (33%) received prehospital ABT, predominantly 3rd generation cephalosporins (74%).
  • No serious adverse effects were reported with prehospital ABT.
  • Adequate prehospital ABT was associated with a significant reduction in 30-day mortality (aOR = 0.09 [0.01-0.47] after matching; aOR = 0.70 [0.53-0.93] with IPTW).

Conclusions:

  • Probabilistic prehospital ABT is frequently adequate in SS patients managed by mICUs and is linked to decreased 30-day mortality.
  • These findings suggest that prehospital ABT is a vital component of the care bundle for SS.
  • Further prospective research is warranted to confirm these outcomes and solidify the role of prehospital ABT.
Abstract

Keywords:
AdequacyPrehospital probabilistic antibiotic therapySafetySeptic shock

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