• Ling Yan Leung, Hsi-Lan Huang, Kevin Kc Hung, Chi Yan Leung, Cherry Cy Lam, Ronson Sl Lo, Chun Yu Yeung, Peter Joseph Tsoi, Michael Lai, Mikkel Brabrand, Joseph H Walline, and Colin A Graham.
• Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, PR China.
• Eur. J. Intern. Med. 2024 Nov 1; 129: 486148-61.

ObjectivesTo evaluate whether the timing of initial antibiotic administration in patients with sepsis in hospital affects mortality.MethodsThis systematic review and meta-analysis included studies from inception up to 19 May 2022. Interventional and observational studies including adult human patients with suspected or confirmed sepsis and reported time of antibiotic administration with mortality were included. Data were extracted by two independent reviewers. Summary estimates were calculated by using random-effects model. The primary outcome was mortality.ResultsWe included 42 studies comprising 190,896 patients with sepsis. Pooled data showed that the OR for patient mortality who received antibiotics ≤1 hr was 0.83 (95 %CI: 0.67 to 1.04) when compared with patients who received antibiotics >1hr. Significant reductions in the risk of death in patients with earlier antibiotic administration were observed in patients ≤3 hrs versus >3 hrs (OR: 0.80, 95 %CI: 0.68 to 0.94) and ≤6 hrs vs 6 hrs (OR: 0.57, 95 %CI: 0.39 to 0.82).ConclusionsOur findings show an improvement in mortality in sepsis patients with early administration of antibiotics at <3 and <6 hrs. Thus, these results suggest that antibiotics should be administered within 3 hrs of sepsis recognition or ED arrival regardless of the presence or absence of shock.Copyright © 2024. Published by Elsevier B.V.

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