Delay of appropriate antibiotic treatment is associated with high mortality in patients with community-onset sepsis in a Swedish setting

• Published in: European journal of clinical microbiology & infectious diseases Vol. 38; no. 7; pp. 1223 - 1234
• Main Authors: Andersson, Maria, Östholm-Balkhed, Åse, Fredrikson, Mats, Holmbom, Martin, Hällgren, Anita, Berg, Sören, Hanberger, Håkan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2019; Springer Nature B.V
• Subjects: Antibiotics; Biomedical and Life Sciences; Biomedicine; Communities; Delay; Dosage; Electrical impedance; Emergency medical services; Internal Medicine; Medical Microbiology; Mortality; Original; Original Article; Patients; Risk analysis; Risk groups; Sepsis; Septic shock; Sepsis; Septic shock; Emergency department; Antibiotics; Mortality
• ISSN: 0934-9723; 1435-4373; 1435-4373
• DOI: 10.1007/s10096-019-03529-8

Early appropriate antimicrobial therapy is crucial in patients with sepsis and septic shock. Studies often focus on time to first dose of appropriate antibiotics, but subsequent dosing is equally important. Our aim was to investigate the impact of fulfillment of early treatment, with focus on appropriate administration of first and second doses of antibiotics, on 28-day mortality in patients with community-onset severe sepsis and septic shock. A retrospective study on adult patients admitted to the emergency department with community-onset sepsis and septic shock was conducted 2012–2013. The criterion “early appropriate antibiotic treatment” was defined as administration of the first dose of adequate antibiotics within 1 h, and the second dose given with less than 25% delay after the recommended dose interval. A high-risk patient was defined as a septic patient with either shock within 24 h after arrival or red triage level on admittance according to the Medical Emergency Triage and Treatment System Adult. Primary endpoint was 28-day mortality. Of 90 patients, less than one in four (20/87) received early appropriate antibiotic treatment, and only one in three (15/44) of the high-risk patients. The univariate analysis showed a more than threefold higher mortality among high-risk patients not receiving early appropriate antibiotic treatment. Multivariable analysis identified early non-appropriate antibiotic treatment as an independent predictor of mortality with an odds ratio for mortality of 10.4. Despite that the importance of early antibiotic treatment has been established for decades, adherence to this principle was very poor.