Clinical InvestigationPrognostic Value of Timing of Antibiotic Administration in Patients With Septic Shock Treated With Early Quantitative Resuscitation
Section snippets
Patients
This retrospective cohort study of prospectively collected data was performed at an urban academic adult ED at a tertiary referral center with an annual census of more than 100,000 patients. The study was approved by the Research Ethics Committee of the hospital. A total of 715 consecutive septic shock adult patients (≥ 18 years old) who fulfilled the septic shock criteria were prospectively added to the septic shock registry from January 2010 to December 2012. From this registry, we
RESULTS
Of the 715 adult patients with severe sepsis and septic shock who were enrolled in the registry, we excluded 212 patients who were transferred from another hospital, 39 patients who received antibiotics before shock recognition and 38 patients who had a “do not attempt resuscitation” status, leaving 426 patients for analysis. The mean age of these patients was 62.9 years, and 260 patients (61.0%) were male. Overall, 340 patients survived and 86 patients expired, yielding a 28-day mortality rate
DISCUSSION
The optimal timing of antibiotic administration and its impact on patient outcome remain unclear. Our results showed that there was no significant association between the shock recognition-to-initial antibiotic administration interval and 28-day mortality in septic shock patients treated with an early quantitative resuscitation protocol in an ED. The illness severity and achievement of resuscitation goals were the most important determinants of outcome in these patients.
Management of septic
CONCLUSIONS
Although there is a relationship between hourly delays in initial antibiotic administration and mortality in patients who undergo quantitative resuscitation in EDs, it is likely not as large as suggested by the study of Kumar et al. Each hourly delay in antibiotic administration is of less importance than ensuring antibiotics are administered during the initial resuscitative phase. The severity of illness seems to be a more important determinant of the clinical outcome than the timing of
REFERENCES (25)
- et al.
The surviving sepsis Campaign guidelines 2012: update for emergency physicians
Ann Emerg Med
(2014) - et al.
Septic shock
Lancet
(2005) - et al.
Improving door-to-antibiotic time in severely septic emergency department patients
J Emerg Med
(2012) - et al.
Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock
Chest
(2007) - et al.
Translating research to clinical practice: a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department
Chest
(2006) - et al.
Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care
Crit Care Med
(2001) - et al.
The epidemiology of sepsis in the United States from 1979 through 2000
N Engl J Med
(2003) - et al.
Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department
Crit Care Med
(2010) - et al.
Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol
Crit Care Med
(2011) - et al.
Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012
Crit Care Med
(2013)
Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008
Intensive Care Med
Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock
Crit Care Med
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The authors have no financial or other conflicts of interest to disclose.