Reevaluating the 1 Hour Benchmark: Associations Between Antibiotic Timing and Mortality in Pediatric Sepsis

Retrospective cohort study evaluating the association between time to antibiotic administration and clinical outcomes in pediatric sepsis using data from 6153 patients treated at 19 pediatric emergency departments between 2013 and 2016. Time to antibiotics was analyzed both as a continuous variable and as a dichotomized variable (≤60 vs >60 minutes from sepsis time zero). The primary outcome was 3- and 30-day all-cause mortality; secondary outcomes included use of vasoactive agents and intensive care unit and hospital length of stay. In adjusted analyses, longer time to antibiotics was associated with lower 30-day mortality but not with 3-day mortality or other secondary outcomes. Patients receiving antibiotics more than 60 minutes from recognition had a significantly lower risk of 30-day mortality. These findings suggest that rigid time-based antibiotic thresholds may not align with improved outcomes in pediatric sepsis and underscore the need for prospective studies to inform future guidelines.