Effect of Immediate Administration of Antibiotics in Patients With Sepsis in Tertiary Care: A Systematic Review and Meta-analysis

Abstract

Immediate antibiotic administration (<1 hour) seemed to reduce patient mortality. There was some minor negative asymmetry suggesting that the evidence may be biased toward the direction of effect. Nevertheless, this study provides strong evidence for early, comprehensive, sepsis management in the emergency department.

Predictors for delayed antibiotic administration among bacteraemic patients in the Emergency Department: Differences between medical and surgical interns

“…4 Surviving Sepsis Campaign guidelines promote that antibiotics should be administered within 1 hour from sepsis recognition, since delay in antibiotic administration is associated with increased morbidity and mortality, 3,4 although the exact timing of antibiotic administration is still debated. [6][7][8] Sterling et al found no significant survival benefit if antibiotics were administered within 3 hours of ED triage or within 1 hour of shock recognition, 7 while Johnston et al suggested that antibiotic administration in septic patients within 1 hour reduced mortality. 6 Apart from timing of antibiotic administration, its appropriateness is of utmost importance.…”

“…[6][7][8] Sterling et al found no significant survival benefit if antibiotics were administered within 3 hours of ED triage or within 1 hour of shock recognition, 7 while Johnston et al suggested that antibiotic administration in septic patients within 1 hour reduced mortality. 6 Apart from timing of antibiotic administration, its appropriateness is of utmost importance. In the present study, 91.8% received an appropriate empiric antibiotic treatment.…”

“…Surviving Sepsis Campaign guidelines recommended that antibiotics should be initiated within hour from sepsis recognition. 4 Even though some studies have shown a beneficial effect of such a rapid antibiotic administration 3,6 many studies failed to find an association between antibiotic administration within 1 hour and improved survival 7 ; thus the proposed schedule of antibiotic administration remains a subject of debate. 8 The early administration of antimicrobials is often challenging since it is influenced by several patient and hospital-related factors.…”

Review article: Sepsis in the emergency department – Part 3: Treatment

“…No association between time to antibiotic and outcome was found in other studies of patients with sepsis in the ED, bacteraemia and neutropaenia . Results of systematic reviews of observational studies have been inconsistent . In a recent large randomised controlled trial (RCT) investigating efficacy of pre‐hospital antibiotics for patients with infection, antibiotic therapy (ceftriaxone) was administered 96 min earlier in the intervention arm (26 min before triage compared to 70 min after) without mortality benefit (8% at 28 days in both groups) .…”

Early Antimicrobial Therapy for Sepsis: Does Each Hour Really Count?

“…Interestingly, a second systematic review and meta-analysis of patients with sepsis showed a significant 33% reduction in mortality odds when antibiotics were administered within 1 hour compared with more than 1 hour. 55 The statistical methods used in these two studies were different as were the methods of selection of the articles. Globally, all these data support the recommendations of the surviving sepsis campaign for an early administration of the antibiotics in sepsis and septic shock.…”