• Michael G Usher, Roshan Tourani, Ben Webber, Christopher J Tignanelli, Sisi Ma, Lisiane Pruinelli, Michael Rhodes, Nishant Sahni, OlsonAndrew P JAPJDivision of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN., Genevieve B Melton, and Gyorgy Simon.
• Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
• Crit. Care Med. 2022 May 1; 50 (5): 799809799-809.

ObjectivesSepsis remains a leading and preventable cause of hospital utilization and mortality in the United States. Despite updated guidelines, the optimal definition of sepsis as well as optimal timing of bundled treatment remain uncertain. Identifying patients with infection who benefit from early treatment is a necessary step for tailored interventions. In this study, we aimed to illustrate clinical predictors of time-to-antibiotics among patients with severe bacterial infection and model the effect of delay on risk-adjusted outcomes across different sepsis definitions.DesignA multicenter retrospective observational study.SettingA seven-hospital network including academic tertiary care center.PatientsEighteen thousand three hundred fifteen patients admitted with severe bacterial illness with or without sepsis by either acute organ dysfunction (AOD) or systemic inflammatory response syndrome positivity.Measurements And Main ResultsThe primary exposure was time to antibiotics. We identified patient predictors of time-to-antibiotics including demographics, chronic diagnoses, vitals, and laboratory results and determined the impact of delay on a composite of inhospital death or length of stay over 10 days. Distribution of time-to-antibiotics was similar across patients with and without sepsis. For all patients, a J-curve relationship between time-to-antibiotics and outcomes was observed, primarily driven by length of stay among patients without AOD. Patient characteristics provided good to excellent prediction of time-to-antibiotics irrespective of the presence of sepsis. Reduced time-to-antibiotics was associated with improved outcomes for all time points beyond 2.5 hours from presentation across sepsis definitions.ConclusionsAntibiotic timing is a function of patient factors regardless of sepsis criteria. Similarly, we show that early administration of antibiotics is associated with improved outcomes in all patients with severe bacterial illness. Our findings suggest identifying infection is a rate-limiting and actionable step that can improve outcomes in septic and nonseptic patients.Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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