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

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.