Can pre‐hospital administration reduce time to initial antibiotic therapy in septic patients?

Cudini, Daniel; Smith, Karen; Bernard, Stephen; Stephenson, Michael; Andrew, Emily; Cameron, Peter; Lum, Mark; Udy, Andrew; Investigators, Arise

doi:10.1111/1742-6723.13282

Cited by 6 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, among 2,740 patients with sepsis transported by EMS in Alberta between April 2015 and March 2016, the median interval from EMS arrival on scene until ED arrival was 41 minutes and the median time from ED arrival until MD assessment was 44 minutes, a total of 85 minutes (8). Similarly, in the Australasian Resuscitation in Sepsis Evaluation (ARISE) study, the median interval from when EMS reached the patient until they unloaded the stretcher in the ED was 60 minutes, followed by an additional 74 minutes until antibiotics were administered (total 134 min; interquartile range [IQR], 97–182 min) (9). These studies not only highlight the potential opportunity for prehospital administration of antibiotics but also the critical role of the EMS system in early identification and ED prenotification (10).…”

mentioning

confidence: 99%

Turning Back the Clock: Prehospital Antibiotics for Patients With Septic Shock*

Goldberg

2022

Critical Care Medicine

View full text Add to dashboard Cite

protocols in a medical-surgical ICU and used quantitative cultures to confirm the diagnosis of VAP. It was only quasi-randomized and single center-but found a significant reduction in VAP with CCPC. Three of the trials were published in Chinese and were not accessible in English, but each is smaller with methodologic shortcomings according to Maertens et al (1).Even though maintaining cuff pressure in the range of 20-30 cm H 2 O is the standard practice in most ICUs, one recent quasi-randomized trial in medical ICU patients found no benefit of the usual practice of checking cuff pressure every 8 hours compared with checking it only on intubation and when there was an obvious cuff leak or the endotracheal tube position had changed (10). The occurrence rate of ventilator-associated events, mortality, and hospital length of stay was the same in both groups. Perhaps, the focus on maintaining cuff pressure is unwarranted.Given the uncertainty of the evidence, and, importantly, that none of the devices tested has demonstrated benefit in a prospective, multicenter, randomized clinical trial, it is not yet time to conclude that continuous control of cuff pressure will decrease the occurrence rate of VAP.

show abstract

mentioning

confidence: 99%

Turning Back the Clock: Prehospital Antibiotics for Patients With Septic Shock*

Goldberg

2022

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…The recent update of the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 (SSC2021) recommended early antibiotic therapy, ideally within 1 to 3 hours of diagnosis of sepsis and within the first hour in cases of septic shock. 4 According to evidence-based medicine, emergency medical services play a crucial role in the delivery of sepsis care bundles [5][6][7][8][9][10] and reducing the time to antibiotic therapy; 7,11,12 however, a recent randomized controlled trial which evaluated the effect of early prehospital antibiotic therapy administration in patients with suspected infection showed negative results in terms of reducing mortality. 13 Nonetheless, several studies have found that prehospital antibiotic administration is associated with lower mortality, particularly in patients with septic shock.…”

Section: Introductionmentioning

confidence: 99%

Impact of Prehospital Antibiotics on in-Hospital Mortality in Emergency Medical Service Patients with Sepsis

Kotnarin,

Sirinawee,

Supasaovapak

2023

OAEM

View full text Add to dashboard Cite

Background Sepsis is a life-threatening medical condition that requires early recognition and timely management to improve patient outcomes and reduce mortality rates. Administering antibiotics in the prehospital setting can be effective to reduce the time to antibiotic therapy, which may be crucial for sepsis patients. However, the impact of prehospital antibiotics on mortality in sepsis patients remains uncertain, and the current evidence to support this practice in middle-income countries is particularly limited. Methods This was a single-center, retrospective-prospective cohort study aimed at determining the impact of prehospital antibiotics on in-hospital mortality rates among adult patients with sepsis. The study included patients who received care from the advanced level of Emergency Medical Service between June 2020 and October 2022 and compared the mortality rates of patients who received prehospital antibiotics with those of their counterparts who did not. Results In this study, 180 patients with a mean age of 71.6 ± 15.7 years were included, of whom 68.9% experienced respiratory infections. The results demonstrated that the prehospital antibiotic group had a significantly lower in-hospital mortality rate (32.2%) than the non-prehospital antibiotic group (47.8%; p=0.034). After adjusting for confounding factors, the odds ratio was 0.304 (95% CI: 0.11, 0.82; p=0.018), indicating a 69.6% lower incidence of in-hospital mortality in the prehospital antibiotic group. Furthermore, the prehospital antibiotic group received antibiotics significantly earlier (16.0 ± 7.4 minutes) than the non-prehospital group (50.9 ± 29.4 minutes; p<0.001). Conclusion This study provides evidence to support the administration of antibiotics to sepsis patients in the prehospital setting, as this practice can reduce mortality rates. However, larger, multicenter studies are required to confirm these findings and to further investigate the potential benefits of prehospital antibiotics in improving patient outcomes.

show abstract