Time to Initiation of Antibiotic Therapy in Critically Ill Patients with Suspected Sepsis and Its Effect on Intensive...

Sepsis is a leading cause of intensive care unit (ICU) admission and mortality. Although early antibiotic therapy in the emergency department improves outcomes, the clinical impact of delays in ICU-based antibiotic escalation is not well established. This study evaluated the association between time to ICU-based initiation of newly prescribed antibiotics and ICU mortality using a Bayesian analytical framework.

A prospective observational study (2019-2021) was conducted in a tertiary care hospital, including adult patients admitted to the ICU. New antibiotic administration represented an escalation of therapy for suspected new-onset or worsening infection. Delay was defined as the interval between prescription and actual administration. Repeated antibiotic escalation events within patients were analyzed using a Bayesian generalized linear mixed model (GLMM) accounting for within-patient correlation.

A total of 695 antibiotic escalation events occurred in 467 patients (mean age 50.6 ± 17.7 years; 61.7% male). The majority of patients received antibiotics within 3 hours of sepsis recognition (90.6%), and 42.8% within 1 hour. Intensive care unit mortality was 25.9%. Each hour delay in administration of newly prescribed ICU antibiotics was associated with increased odds of ICU mortality [posterior odds ratio (OR): 1.13, 95% credible interval (CrI): 1.11-1.15]. Higher mortality was also associated with septic shock, hospital-acquired infection, higher delta sequential organ failure assessment (Δ SOFA), and higher Acute Physiology and Chronic Health Evaluation (APACHE II) Score.

Delays in ICU-based antibiotic escalation are associated with increased mortality. Timely escalation may represent an important, modifiable target to improve outcomes in critically ill patients with suspected sepsis.

Havaldar AA, Saji A, Thomas T, Selvam M, Josy J, Nandhini CS, et al. Time to Initiation of Antibiotic Therapy in Critically Ill Patients with Suspected Sepsis and Its Effect on Intensive Care Unit Mortality: Analysis Using Bayesian Approach. Indian J Crit Care Med 2026;30(3):204-210.