HOW EARLY DO ANTIBIOTICS HAVE TO BE TO IMPACT MORTALITY IN SEVERE SEPSIS? A PROSPECTIVE, OBSERVATIONAL STUDY FROM AN EMERGENCY DEPARTMENT
AbstractBackground: 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) tothe 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 significantdifferences between timing of antibiotic administration and survival, two-sided p values <0.05 wereconsidered significant. Results: One hundred and eleven patients were enrolled. Severe sepsis waspresent in 52% patients; the most frequent organism isolated was Salmonella typhi (18%). Overallmortality was 35.1%. One hundred (90.1%) patients received intravenous antibiotics in theEmergency room; average time from triage to actual administration was 2.48±1.86 hours. The timingof 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 withevery 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 inthe population presenting to our emergency room, each hourly delay in antibiotic administration wasassociated with an increase in mortality.Keywords: sepsis, shock, antibiotics, emergency department
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