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. 2017 May;45(5):759-765.
doi: 10.1097/CCM.0000000000002264.

Delays From First Medical Contact to Antibiotic Administration for Sepsis

Christopher W Seymour  1 , Jeremy M Kahn, Christian Martin-Gill, Clifton W Callaway, Donald M Yealy, Damon Scales, Derek C Angus
Affiliations

Delays From First Medical Contact to Antibiotic Administration for Sepsis

Christopher W Seymour et al. Crit Care Med. 2017 May.

Abstract

Objective: To evaluate the association between total medical contact, prehospital, and emergency department delays in antibiotic administration and in-hospital mortality among patient encounters with community-acquired sepsis.

Design: Retrospective cohort study.

Setting: Nine hospitals served by 21 emergency medical services agencies in southwestern Pennsylvania from 2010 through 2012.

Patients: All emergency medical services encounters with community acquired sepsis transported to the hospital.

Measurements and main results: Among 58,934 prehospital encounters, 2,683 had community-acquired sepsis, with an in-hospital mortality of 11%. Median time from first medical contact to antibiotic administration (total medical contact delay) was 4.2 hours (interquartile range, 2.7-8.0 hr), divided into a median prehospital delay of 0.52 hours (interquartile range, 0.40-0.66 hr) and a median emergency department delay of 3.6 hours (interquartile range, 2.1-7.5 hr). In a multivariable analysis controlling for other risk factors, total medical contact delay was associated with increased in-hospital mortality (adjusted odds ratio for death, 1.03 [95% CI, 1.00-1.05] per 1-hr delay; p < 0.01), as was emergency department delay (p = 0.04) but not prehospital delay (p = 0.61).

Conclusions: Both total medical contact and emergency department delay in antibiotic administration are associated with in-hospital mortality in community-acquired sepsis.

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Conflict of interest statement

Dr. Martin-Gill has disclosed that he does not have any potential conflicts of interest.

Figures

Figure 1
Figure 1
Delays in antibiotic administration in sepsis. ED = emergency department.
Figure 2
Figure 2
Patient accrual. EMS = emergency medical services.
Figure 3
Figure 3
Association between medical contact delay and in-hospital mortality in community-acquired sepsis. The Surviving Sepsis campaign (SSC) criteria for organ dysfunction that were measurable in our electronic health record extract included: hypotension (SBP, ≤ 90 mm Hg), lactate greater than or equal to 2.0 mmol/L, Pao2/Fio2 ratio less than or equal to 250, serum creatinine greater than 2.0 mg/dL, total bilirubin greater than 2.0 mg/dL, platelet count less than 100,000 μL, or international normalized ratio greater than 1.5. OR = odds ratio, SBP = systolic blood pressure, SOFA = Sepsis-Related Organ Failure Assessment score.
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References

    1. Kumar A, Haery C, Paladugu B, et al. The duration of hypotension before the initiation of antibiotic treatment is a critical determinant of survival in a murine model of Escherichia coli septic shock: Association with serum lactate and inflammatory cytokine levels. J Infect Dis. 2006;193:251–258. - PubMed
    1. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589–1596. - PubMed
    1. Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: Results from a guideline-based performance improvement program. Crit Care Med. 2014;42:1749–1755. - PubMed
    1. Sterling SA, Miller WR, Pryor J, et al. The impact of timing of antibiotics on outcomes in severe sepsis and septic shock: A systematic review and meta-analysis. Crit Care Med. 2015;43:1907–1915. - PMC - PubMed
    1. Cooke CR, Iwashyna TJ. Sepsis mandates: Improving inpatient care while advancing quality improvement. JAMA. 2014;312:1397–1398. - PMC - PubMed

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