Format

Send to

Choose Destination
Crit Care. 2015 Apr 29;19:194. doi: 10.1186/s13054-015-0936-3.

The association between time to antibiotics and relevant clinical outcomes in emergency department patients with various stages of sepsis: a prospective multi-center study.

Author information

1
Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands. b.de_groot.SEH@lumc.nl.
2
Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands. annemiekeansems@hotmail.com.
3
Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands. d.h.gerling@umail.leidenuniv.nl.
4
Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands. mail2@douwerijpsma.nl.
5
VU Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. p.vanamstel@vumc.nl.
6
VU Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. durklinzel@gmail.com.
7
VU Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. pj.kostense@vumc.nl.
8
VU Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. m.jonker2@vumc.nl.
9
Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands. e.de_jonge@lumc.nl.

Abstract

INTRODUCTION:

In early sepsis stages, optimal treatment could contribute to prevention of progression to severe sepsis. Therefore, we investigated if there was an association between time to antibiotics and relevant clinical outcomes in hospitalized emergency department (ED) patients with mild to severe sepsis stages.

METHODS:

This is a prospective multicenter study in three Dutch EDs. Patients were stratified into three categories of illness severity, as assessed by the predisposition, infection, response, and organ failure (PIRO) score: PIRO score 1 to 7, 8 to 14 and >14 points, reflected low, intermediate, and high illness severity, respectively. Consecutive hospitalized ED patients with a suspected infection who were treated with intravenous antibiotics were eligible to participate in the study. The primary outcome measure was the number of surviving days outside the hospital at day 28 which was used as an inverse measure of hospital length of stay (LOS). The secondary outcome measure was 28-day mortality, taking into account the time to mortality. Multivariable Cox regression analysis was used to estimate the association between time to antibiotics and the primary and secondary outcome measures corrected for confounders, including appropriateness of antibiotics and initial ED resuscitation, in three categories of illness severity.

RESULTS:

Of the 1,168 included patients, 112 died (10%), while 85% and 95% received antibiotics within three and six hours, respectively. No association between time to antibiotics and surviving days outside the hospital or mortality was found. Only in PIRO group 1 to 7 was delayed administration of antibiotics (>3 hours) associated with an increase in surviving days outside the hospital at day 28 (hazard ratio: 1.46, 95% confidence interval: 1.05 to 2.02 after correction for potential confounders).

CONCLUSIONS:

In ED patients with mild to severe sepsis who received antibiotics within six hours after ED presentation, a reduction in time to antibiotics was not found to be associated with an improvement in relevant clinical outcomes.

PMID:
25925412
PMCID:
PMC4440486
DOI:
10.1186/s13054-015-0936-3
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center