Prognostic value of timing of antibiotic administration in patients with septic shock treated with early quantitative resuscitation.

BACKGROUND: The Surviving Sepsis Campaign recommends initiating broad-spectrum antibiotic treatment within 1 hour of septic shock recognition. However, there is controversy regarding this owing to contradictory studies. This study investigated the relationship between the antibiotic administration interval and 28-day mortality in septic shock patients treated with an early quantitative resuscitation protocol in an emergency department (ED).

METHODS: 715 consecutive septic shock patients were prospectively collected from January 2010 to December 2012. Of these, 426 patients developed shock at or after initial assessment, and the time of initial antibiotic administration was recorded. The primary outcome was 28-day mortality.

RESULTS: The median antibiotic administration interval was 91.5 (47.0-158.0) minutes, and the 28-day mortality was 20.0%. Mortality did not change with hourly delays in antibiotic administration up to 5 hours after shock recognition: 1 hour (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.45-1.45), 2 hours (OR: 0.72, 95% CI: 0.40-1.29) and 3 hours (OR: 0.61, 95% CI: 0.30-1.25). However, inability to achieve early resuscitation goals (OR: 1.94, 95% CI: 1.07-3.51), sequential organ failure assessment score (OR: 1.30, 95% CI: 1.17-1.44) and lactic acid concentration (OR: 1.66, 95% CI: 1.11-2.49) were significantly associated with an increased risk of 28-day mortality.

CONCLUSIONS: Among septic shock patients who underwent early quantitative resuscitation in an ED, mortality did not increase with hourly delays in antibiotic administration. These data call into question the strength of the association between hourly delays in antibiotic administration and mortality in septic shock patients.