HOW EARLY DO ANTIBIOTICS HAVE TO BE TO IMPACT MORTALITY IN SEVERE SEPSIS? A PROSPECTIVE, OBSERVATIONAL STUDY FROM AN EMERGENCY DEPARTMENT
Abstract
Background: The objective of this study was to assess the promptness of antibiotic administration topatients presenting with sepsis and the effects on survival and length of hospitalization. Methods:
Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to
the emergency department of the Aga Khan University hospital were enrolled in a prospective,
observational study over a period of 4 months. Univariate, multivariate regression modeling and oneway ANOVA were used to examine the effects of various variables on survival and for significant
differences between timing of antibiotic administration and survival, two-sided p values <0.05 were
considered significant. Results: One hundred and eleven patients were enrolled. Severe sepsis was
present in 52% patients; the most frequent organism isolated was Salmonella typhi (18%). Overall
mortality was 35.1%. One hundred (90.1%) patients received intravenous antibiotics in the
Emergency room; average time from triage to actual administration was 2.48±1.86 hours. The timing
of antibiotic administration was significantly associated with survival (F statistic 2.17, p=0.003).
Using a Cox Regression model, we were able to demonstrate that survival dropped acutely with
every hourly delay in antibiotic administration. On multivariate analysis, use of vasopressors
(adjusted OR 23.89, 95% CI 2.16,263, p=0.01) and Escherichia coli sepsis (adjusted OR 6.22, 95%
CI 1.21,32, p=0.03) were adversely related with mortality. Conclusions: We demonstrated that in
the population presenting to our emergency room, each hourly delay in antibiotic administration was
associated with an increase in mortality.
Keywords: sepsis, shock, antibiotics, emergency department
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