Association between timing and adequacy of antibiotics and adverse outcomes in patients with sepsis and septic shock: A multicentre retrospective cohort study

Abstract

Objectives: To investigate the association between the timing and adequacy of antibiotics administered to patients presenting with culturepositive sepsis and septic shock to the ED and in-hospital mortality and/or intensive care unit (ICU) admission. Methods: Multicentre retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia between January 2017 and November 2019. Encounters for patients aged ≥16 years meeting specified criteria for sepsis or septic shock with antibiotic administration within the first 6 h of presentation were included. Results: Of 7611 encounters included in the study, 2328 (31%) were culture positive, and 2228 (29%) met the criteria for septic shock. In culturepositive sepsis encounters, partial or inadequate antibiotic coverage was associated with higher risk of death or ICU admission (adjusted odds ratio [AOR] 1.50, 95% confidence interval [CI] 1.04-2.06 and 1.95, 95% CI 1.28-2.99, respectively). This effect was not significant in septic shock encounters (AOR 1.10, 95% CI 0.64-1.88) with partial coverage and (AOR 1.63, 95% CI 0.81-3.3) inadequate coverage. Time to antibiotics was not significantly associated with the risk of mortality/ICU admission. This inference remained the same when analysis was restricted to cases with adequate antibiotic coverage. Conclusions: In a large multicentre sample of patients with culture-positive sepsis, inadequacy of antibiotics was associated with higher risk of inhospital mortality or ICU admission.

Comparison of clinical characteristics and outcomes of patients with sepsis identified by the Sepsis‐3 criteria by blood and urine culture results: A multicentre retrospective cohort study

“…Secondly, our findings reinforce the importance of timing the collection of blood and other relevant cultures to precede antibiotic administration, while also observing guidelines to administer antibiotics within 1 h of presentation 29 . This is a requirement to optimize pathogen detection and tailor antibiotic therapy accordingly, which has significant impact on patient outcomes 33 . Lastly, it is worth further investigation into barriers to compliance with guidelines that recommend collection of two sets of blood cultures in suspected sepsis cases.…”

“… 29 This is a requirement to optimize pathogen detection and tailor antibiotic therapy accordingly, which has significant impact on patient outcomes. 33 Lastly, it is worth further investigation into barriers to compliance with guidelines that recommend collection of two sets of blood cultures in suspected sepsis cases.…”

Designing a simple and efficient phage biocontainment system using the amber suppressor initiator tRNA

“…However, widespread administration is leading to the development and spread of multidrug-resistant (MDR) pathogenic bacteria. Consequently, patients infected with MDR pathogens have increased hospital stays [1,2] and higher mortality rates [3]. The overuse of antibiotics also disrupts the microbiome [4] and may exacerbate chronic conditions from kidney disease to obesity [5].…”

Response to Re: Association between timing and adequacy of antibiotics and adverse outcomes in patients with sepsis and septic shock: A multicentre retrospective cohort study

“…Dear Editor, We appreciate the opportunity to respond to the letter by Ito 1 in reference to our original publication. 2 Ito makes some valuable points regarding adjusting for severity of sepsis when assessing the timing of antibiotic administration. Our study analysis has already adjusted for sepsis severity, using modified sequential organ failure assessment (mSOFA) score, and explained in the Methods section.…”