Prehospital administration of broad‐spectrum antibiotics for sepsis patients: A systematic review and meta‐analysis

Abstract

Background and Aims Some studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta‐analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients. Methods We formulated a search strategy and used it on search databases PubMed, Scopus, Web of Science, and Embase. We then screened the records for eligibility and included controlled studies, either clinical trials or cohort studies reporting prehospital antibiotic administration for sepsis patients. We excluded duplicates, books, conferences' abstracts, case reports, editorials, letters, author responses, not English studies, and studies with nonavailable full text. Animal and lab studies were also excluded. Results The total number of studies identified is 1811, 19 were eligible for systematic review and 4 for meta‐analysis (three cohort and one clinical trial). The total number of sepsis patients in the four included studies in the 28 days mortality outcome was 3523 (1779 took prehospital antibiotics and 1744 did not take prehospital antibiotics). Of 1779 who took the antibiotics, 190 died, and of 1744 who did not take antibiotics, 292 died (95% confidence interval 0.68–0.97, p = 0.02). Conclusion This meta‐analysis reveals that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. However, more clinical trials and multicenter prospective studies with high sample sizes are needed to get strong evidence supporting our findings.

Prehospital administration of antibiotics in addition to usual care versus usual care alone for patients with suspected sepsis – a systematic review

“…For the secondary outcomes of length of stay for hospital generally and ICU, there was no evidence of good quality at low risk of bias to indicate reductions favouring prehospital administration of antibiotics. The conclusions drawn here differ from those drawn by Varney et al 18 in a 2022 systematic review and meta-analysis, who concluded that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. The authors meta-analysed four studies reporting comparisons between prehospital antibiotics and usual care (two RCTs and two observational), reporting a risk ratio (RR) favouring prehospital antibiotics (RR 0.81; 95% CI 0.68-0.97; p = 0.02).…”

“…Finally, the methodological and clinical heterogeneity present amongst the studies included by Varney et al suggest that a combined meta-analysis was inappropriate. Combining observational and clinical trials in a single meta-analysis requires complex analytic modelling using meta-regression or quality effects modelling 36 ; this appears not to have been addressed in Varney et al, 18 hence the overall meta-analysis result favouring prehospital antibiotics should be interpreted with caution.…”

“…10,16 Prehospital administration of antibiotics has been described in a number of largely observational studies generally describing case series or non-comparative cohort studies, summarised in two systematic reviews in 2016 and 2022. 17,18 The 2016 review by Smyth et al 7 examining prehospital care interventions for sepsis broadly, reported no evidence to support prehospital administration of antibiotics, with only one of 19 included papers presenting mortality-based outcome data. The 2022 review of nineteen studies by Varney et al, 18 which included a meta-analysis of four studies of varying methodology, concluded prehospital administration can reduce mortality compared to usual care (oxygen and intravenous fluids).…”

“…17,18 The 2016 review by Smyth et al 7 examining prehospital care interventions for sepsis broadly, reported no evidence to support prehospital administration of antibiotics, with only one of 19 included papers presenting mortality-based outcome data. The 2022 review of nineteen studies by Varney et al, 18 which included a meta-analysis of four studies of varying methodology, concluded prehospital administration can reduce mortality compared to usual care (oxygen and intravenous fluids). The conflict in findings between these existing reviews, publication of new research, 19 concerns regarding the methodology used by Varney et al 18 regarding their mortality meta-analysis, inclusion of unreferenced studies, and lack of certainty of evidence assessment, collectively serve as justification for the conduct of this current review that sought to analyse studies presenting comparative data.…”

Does Prehospital Suspicion of Sepsis Shorten Time to Administration of Antibiotics in the Emergency Department? A Retrospective Study in One University Hospital

“…Antibiotics could more routinely be administered in the prehospital setting. A recent metaanalysis found a significant reduction in the 28-day mortality rate when patients received a first dose of a broad-spectrum antibiotic in the prehospital field compared to standard care [17]. An acceleration of the management of patients where the diagnosis has already been made is probably the easiest way to further improve outcomes.…”