Examining the Association Between Septic Shock Mortality and Early Antibiotic Use

Patients with septic shock who were administered antibiotics within an hour of onset had decreased in-hospital mortality rates.

Patients with septic shock who were administered antibiotics within an hour of onset had decreased mortality rates, according to the results of a recent study published in The American Journal of Medicine.

Data from patients experiencing sceptic shock at 10 emergency departments were analyzed with respect to timelines of first antibiotic administration. Patients were divided into 4 groups: group 1 consisted of patients administered antibiotics within 1 hour, group 2 were administered antibiotics within 1 to2 hours, group 3 within 2 to3 hours, and finally group 4 with >3 hours before antibiotic administration. The primary end point was in-hospital mortality.

Of the 2250 patients with septic shock patients in the analysis, the median time to first antibiotic administration was 2.29 hours. A total of 332 patients received the first antibiotics within 1 hour (group 1), while 610, 538, and 749 patients were categorized into group 2 (1-2 hours), group 3 (2-3 hours), and group 4 (>3 hours), respectively. The in-hospital mortality of patients in groups 2 and 4 were significantly higher than patients in group 1, but mortality in group 3 was not significantly different from group 1.

The study authors noted that to the best of their knowledge, theirs was the first emergency department-based study to address the effectiveness of early antibiotic administration in septic shock outcomes using propensity scores. Previous studies have demonstrated inconsistent results regarding the association of antibiotic administration timing and sepsis and septic shock outcomes. However, other research has indicated specific poor outcomes (eg, length of stay, lung injury, acute kidney injury, and organ failure) associated with antibiotic delays.

“Rapid first antibiotic treatment with [emergency department] triage was generally associated with reduced in-hospital mortality in patients with septic shock; however, a linear association was not observed between each hour delay of first antibiotic administration and in-hospital mortality,” the study authors wrote.

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Ko BS, Choi S-H, Kang GH, et al; for the Korean Shock Society (KoSS) Investigators. Time to antibiotics and the outcome of patients with septic shock: a propensity score analysis. Am J Med. 2020;133(4):485-491.