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INITIAT ‐ E . D .: I mpact of timing of INITI ation of A ntibiotic T herapy on mortality of patients presenting to an Emergency Department with sepsis
Author(s) -
Wisdom Alice,
Eaton Vaughn,
Gordon David,
Daniel Santhosh,
Woodman Richard,
Phillips Cameron
Publication year - 2015
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12394
Subject(s) - medicine , interquartile range , sepsis , antibiotics , triage , retrospective cohort study , cohort , emergency medicine , microbiology and biotechnology , biology
Objectives To analyse the association between time from triage to administration of initial antibiotics and mortality in all patients presenting with sepsis to a tertiary hospital ED . Methods A retrospective review of patients presenting to the ED with sepsis from J anuary to D ecember 2012 was conducted at F linders M edical C entre, S outh A ustralia. Outcome measures were: time elapsed from triage to administration of initial antibiotic therapy and in‐hospital mortality. Results A total of 220 patients presented with sepsis, comprising 102 cases of uncomplicated sepsis and 118 severe sepsis. The median time to antibiotic administration was 3.5 h (interquartile range [ IQR ] 1.7–6.6) and in‐hospital mortality was 28.6% (95% CI 22.6–34.6%). There was no association observed between delays to antibiotics and mortality in the total patient population. When stratified by presenting severity, patients with severe sepsis demonstrated a trend towards increased mortality when delays to antibiotics exceeded 6 h from triage ( HR = 2.25, 95% CI 0.91–5.59, P = 0.08) in comparison with <1 h. Significant delays to antibiotic administration occurred when initial agents were charted as a ‘regular medicine’ (9.4 h, IQR 5.1–16.6) in comparison with a ‘once only order’ (3.4 h, IQR 1.7–6.7), P < 0.001. Conclusions Early administration of antibiotics specifically in patients with severe sepsis might be beneficial. Further studies within the ED are warranted to establish the effect of delayed antibiotics in a generalised sepsis cohort.