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Emergency department door-to-antibiotic time and long-term mortality in sepsis.
Chest. 2019 Feb 16;:
Authors: Peltan ID, Brown SM, Bledsoe JR, Sorensen J, Samore MH, Allen TL, Hough CL
Abstract
BACKGROUND: The impact of antibiotic timing on sepsis outcomes remains controversial due to conflicting results in prior studies. This study investigated the association of door-to-antibiotic time with long-term mortality in emergency department (ED) patients with sepsis.
METHODS: This retrospective cohort study included non-trauma adult ED patients with clinical sepsis admitted to four hospitals from 2013 to 2017. Only patients' first eligible encounter was included. We employed multivariable logistic regression to measure the adjusted association between door-to-antibiotic time and 1-year mortality. Secondary analyses used alternative antibiotic timing measures (antibiotic initiation within one or three hours, separate comparison of antibiotic exposure at each hour up to hour 6), alternative outcomes (hospital, 30-day, and 90-day mortality), and alternative statistical methods to mitigate indication bias.
RESULTS: Among 10,811 eligible patients, median door-to-antibiotic time was 166 (interquartile range 115-230) minutes and 1-year mortality was 19%. After adjustment, each additional hour from ED arrival to antibiotic initiation was associated with a 10% (95% CI 5-14%, p<0.001) increased odds of 1-year mortality. The association remained linear when each one-hour interval of door-to-antibiotic time was independently compared to door-to-antibiotic time ≤1 hour and was similar for inpatient-, 30-day and 90-day mortality. Mortality at one year was higher when door-to-antibiotic times were >3 hours versus ≤3 hours (adjusted odds ratio 1.27, 95% CI 1.13-1.43) but not >1 hour versus ≤1 hour (adjusted odds ratio 1.26, 95% CI 0.98-1.62).
CONCLUSIONS: Delays in ED antibiotic initiation time are associated with clinically important increases in long-term risk-adjusted sepsis mortality.
PMID: 30779916 [PubMed - as supplied by publisher]