Time to administration of antibiotics and mortality in sepsis

OBJECTIVE: To examine the association between delay of antibiotic treatment and 28‐day mortality in a study of septic patients identified by the Sepsis‐3 criteria. METHODS: A prospective observational cohort study of patients (≥ 18 years) with sepsis admitted to a Danish emergency department between October 2017 and March 2018. The interval between arrival to the ED and first delivery of antibiotics was used as time to antibiotic treatment (TTA). Logistic regression was used in the analysis of the association between TTA and mortality adjusted for potential confounding. RESULTS: A total of 590 patients, median age 74.2 years, were included. Overall 28‐day mortality was 14.6% (95% confidence interval [CI], 11.8–17.7). Median TTA was 4.7 hours (interquartile range 2.7–8.1). The mortality in patients with TTA ≤1 hour was 26.5% (95% CI, 12.8–44.4), and 15.3% (95% CI, 9.8–22.5), 10.5% (95% CI, 6.6–15.8), and 12.8 (95% CI, 7.3–20.1) in the timespans 1–3, 3—6, and 6–9 hours, respectively, and 18.8% (95% CI, 12.0–27.2) in patients with TTA >9 hours. With patients with lowest mortality (TTA timespan 3–6 hours) as reference, the adjusted odds ratio of mortality was 4.53 (95% CI, 1.67–3.37) in patients with TTA ≤1 hour, 1.67 (95% CI, 0.83–3.37) in TTA timespan 1–3 hours, 1.17 (95% CI, 0.56–2.49) in timespan 6–9 hours, and 1.91 (95% CI, 0.96–3.85) in patient with TTA >9 hours. CONCLUSIONS: The adjusted odds of 28‐day mortality were lowest in emergency department (ED) patients with sepsis who received antibiotics between 1 and 9 hours and highest in patients treated within 1 and >9 hours after admission to the ED.