The association between mortality and door-to-antibiotic time: a systematic review and meta-analysis

Abstract

Purpose Previous studies evaluating the impact of antibiotic timing on mortality in sepsis have shown conflicting results. We performed a meta-analysis to evaluate the association between door-to-antibiotic time (each hour of delay) and mortality in sepsis. Methods We searched PubMed and Embase through 10 November 2022 to identity cohort studies that evaluated the adjusted association between door-to-antibiotic time (each hour of delay) and mortality in adult patients with sepsis. The primary outcome was mortality. Analysis was based on inverse-variance weighting using a fixed-effects model. The variances were derived from the logarithms of the reported confidence intervals (CIs) for associations. We estimated the odds ratio, 95% CI, and number needed to treat for the pooled data. Results Fifteen cohort studies involving 106 845 patients were included in the meta-analysis. Door-to-antibiotic time (each hour of delay) was associated with increased risk of mortality (odds ratio: 1.07; 95% CI: 1.06–1.08; P < 0.0001; number needed to treat = 91), with high heterogeneity (I2 = 82.2%). The association was robust in sensitivity analyses and consistent in subgroup analyses. No publication bias was found. Conclusion In adult patients with sepsis, each hour of delay in antibiotic administration is associated with increased odds of mortality.

Association of Inappropriate Initial Antibiotic Treatment with 30-Day Mortality in Hematological Malignancies Patients with Klebsiella pneumoniae Bloodstream Infection: A Single-Centre Retrospective Study

“…In these cases, timely and appropriate antimicrobial treatment is crucial. Studies have shown that delays in starting such treatment, or the use of inappropriate antimicrobial regimens, are linked to increased mortality rates (2)(3)(4)(5)(6)(7)(8). Despite the well-recognized importance of early and appropriate antibiotic therapy in managing sepsis, adherence to this principle has been disappointingly low.…”