• Am. J. Med. · Apr 2020

    Observational Study

    Time to Antibiotics and the Outcome of Patients with Septic Shock: A Propensity Score Analysis.

    • Byuk Sung Ko, Sung-Hyuk Choi, Gu Hyun Kang, Tae Gun Shin, Kyuseok Kim, You Hwan Jo, Seung Mok Ryoo, Youn-Jung Kim, Yoo Seok Park, Woon Yong Kwon, Kap Su Han, Han Sung Choi, Sung Phil Chung, Gil Joon Suh, Hyunggoo Kang, Tae Ho Lim, Won Young Kim, and Korean Shock Society (KoSS) Investigators.
    • Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
    • Am. J. Med. 2020 Apr 1; 133 (4): 485-491.e4.

    BackgroundCurrent sepsis guidelines recommend administration of antibiotics within 1 hour of emergency department (ED) triage. However, the quality of the supporting evidence is moderate, and studies have shown mixed results regarding the association between antibiotic administration timing and outcomes in septic shock. We investigated to evaluate the association between antibiotic administration timing and in-hospital mortality in septic shock patients in the ED, using propensity score analysis.MethodsAn observational study using a prospective, multicenter registry of septic shock, comprising data collected from 10 EDs, was conducted. Septic shock patients were included, and patients were divided into 4 groups by the interval from triage to first antibiotic administration: group 1 (≤1 hour; reference), 2 (1-2 hours), 3 (2-3 hours), and 4 (>3 hours). The primary endpoint was in-hospital mortality. After inverse probability of treatment weighting, the outcomes of the groups were compared.ResultsA total of 2250 septic shock patients were included, and the median time to first antibiotic administration was 2.29 hours. The in-hospital mortality of groups 2 and 4 were significantly higher than those of group 1 (odds ratio [OR] 1.248; 95% confidence interval [CI], 1.053-1.478; P = .011; OR 1.419; 95% CI, 1.203-1.675; P < .001, respectively), but those of group 3 was not (OR 1.186; 95% CI, 0.999-1.408; P = .052). Subgroup analyses of patients (n = 2043) with appropriate antibiotics presented similar results.ConclusionsIn patients with septic shock, rapid administration of antibiotics was generally associated with a decrease in in-hospital mortality, but no "every hour delay" was seen.Copyright © 2019 Elsevier Inc. All rights reserved.

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