PURPOSE: Studies have shown that delay greater than 24 hours in time to antibiotic administration (TTAA) results in increased mortality in sepsis. Current guidelines (Surviving Sepsis Campaign) suggest initiation of antibiotics within an hour of recognition of severe sepsis (grade E recommendation). The aim of our study was to determine if TTAA within 24 hours influences outcome.
METHODS: A retrospective chart review identified 44 patients admitted to our medical ICU with severe sepsis or septic shock. Data abstracted included TTAA after identification of sepsis, Acute Physiology and Chronic Health Evaluation (APACHE) IV parameters, hospital mortality, lengths of ICU and hospital stay after diagnosis of sepsis, and days on ventilator, acute dialysis or vasopressor agent. Independent T-test was used to compare continuous variables and two-tailed Fisher Exact test for categorical variables.
RESULTS: Average TTAA was 3.7 hrs (range <1 to 12 hrs). Thirty-two patients were admitted from the emergency department (ED) and 12 from the general medical floor (GMF). Twelve patients died. TTAA was similar in survivors and non-survivors (3.7 vs. 3.8 hrs, p=0.96). There was no difference in mortality when TTAA was ≤;2 hrs vs. >2 hrs (33% vs. 24%, p=0.72), ≤;4 hrs vs. >4 hrs (23% vs. 36%, p=0.48), nor ≤;6 hrs vs. >6 hrs (28% vs. 14%, p=0.65). The factors associated with increased mortality were higher APACHE IV score (p=0.001) and admission from GMF (67% vs. 13%, p=0.01). On multiple regression analysis, these associations remained statistically significant (p=0.003 and p=0.01, respectively). APACHE IV was higher but TTAA was similar in GMF vs. ED patients. TTAA was not associated with increased length of ICU or hospital stay, nor increased incidence or duration of mechanical ventilation, dialysis or vasopressor support.
CONCLUSION: In our cohort, mortality and morbidity was not associated with TTAA but with higher APACHE IV scores and sepsis developing during hospitalization.
CLINICAL IMPLICATIONS: Although TTAA within one hour in severe sepsis seems logical, it may be overly conservative. More studies are needed to identify the optimal widow for TTAA.
DISCLOSURE: Vinay Sharma, No Financial Disclosure Information; No Product/Research Disclosure Information