ED door-to-antibiotic time and long-term mortality in sepsis.

Peltan, Ithan D.; Brown, Samuel M.; Bledsoe, Joseph R.; Sorensen, Jeffrey; Samore, Matthew H.; Allen, Todd L.; Hough, Catherine L.

doi:10.1016/j.chest.2019.02.008

Cited by 243Sepsis Diagnosis and TreatmentAntibiotics Pharmacokinetics and EfficacyEmergency and Acute Care Studies

ED door-to-antibiotic time and long-term mortality in sepsis.

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Peltan, Ithan D., Brown, Samuel M., Bledsoe, Joseph R., Sorensen, Jeffrey, Samore, Matthew H., Allen, Todd L., Hough, Catherine L.·2019·Chest

DOI 10.1016/j.chest.2019.02.008PMC PMC6533450

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Abstract

Background The impact of antibiotic timing on sepsis outcomes remains controversial due to conflicting results from previous studies. Objectives This study investigated the association of door‐to‐antibiotic time with long‐term mortality in ED patients with sepsis. Methods This retrospective cohort study included nontrauma adult ED patients with clinical sepsis admitted to four hospitals from 2013 to 2017. Only patients’ first eligible encounter was included. Multivariable logistic regression was used to measure the adjusted association between door‐to‐antibiotic time and 1‐year mortality. Secondary analyses used alternative antibiotic timing measures (antibiotic initiation within 1 or 3 h and separate comparison of antibiotic exposure at each hour up to hour 6), alternative outcomes (hospital, 30‐day, and 90‐day mortality), and alternative statistical methods to mitigate indication bias. Results Among 10,811 eligible patients, median door‐to‐antibiotic time was 166 min (interquartile range, 115‐230 min), and 1‐year mortality was 19%. After adjustment, each additional hour from ED arrival to antibiotic initiation was associated with a 10% (95% CI, 5‐14; P < .001) increased odds of 1‐year mortality. The association remained linear when each 1‐h interval of door‐to‐antibiotic time was independently compared with door‐to‐antibiotic time ≤ 1 h and was similar for hospital, 30‐day, and 90‐day mortality. Mortality at 1 year was higher when door‐to‐antibiotic times were > 3 h vs ≤ 3 h (adjusted OR, 1.27; 95% CI, 1.13‐1.43) but not > 1 h vs ≤ 1 h (adjusted OR, 1.26; 95% CI, 0.98‐1.62). Conclusions Delays in ED antibiotic initiation time are associated with clinically important increases in long‐term, risk‐adjusted sepsis mortality.

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In a study of 10,811 patients treated in four Utah hospitals, each hour delay from ED arrival to antimicrobial administration was associated with 1.16 increased odds of in-hospital mortality and 1.10 increased odds of 1-year mortality (1.13 in patients with hypotension vs 1.09 in patients without hypotension).
“Finally, in a study of 10,811 patients treated in four Utah hospitals, each hour delay in time from ED arrival to administration of antimicrobials was associated with 1.16 increased odds of in-hospital and 1.10 increased odds of 1-year mortality (1.13 in patients with”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [111]
Observational studies suggest that mortality may increase after intervals exceeding 3-5 h from hospital arrival and/or sepsis recognition.
“Observational studies do, however, suggest that mortality may increase after intervals exceeding 3–5 h from hospital arrival and/or sepsis recognition [98, 111, 119, 120].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [111]

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Authors: Peltan, I. D., Brown, S. M., Bledsoe, J. R., Sorensen, J., Samore, M. H., Allen, T. L., & Hough, C. L.
Affiliations: University of Utah (US)
Intermountain Medical Center (US)
University of Washington (US)
Corresponding author: Peltan, Ithan D.
ORCID: Peltan, Ithan D.
Brown, Samuel M.
Bledsoe, Joseph R.
Samore, Matthew H.
Hough, Catherine L.
Venue: Chest
Publisher: Elsevier BV
Published: 2019-05
Volume: 155
Issue: 5
Pages: 938-946
ISSN: 0012-3692 (ISSN-L)
DOI: 10.1016/j.chest.2019.02.008
PMC: PMC6533450
OpenAlex: W2912904466
Semantic Scholar: 2de1173b3ce087f0bcbeaf594430359df23b8fe2
Cited by: 243
References: 46
Citations by year: 2026: 21 · 2025: 36 · 2024: 31 · 2023: 39 · 2022: 44 · 2021: 38 · 2020: 24 · 2019: 10
FWCI: 22.07
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: CHEST Journal (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: University of Utah
Intermountain Research and Medical Foundation
National Institutes of Health (5ul1tr001067-05, UL1TR002538, UL1TR001067)
National Center for Advancing Translational Sciences (UL1-TR001067)
Topics: Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords: sepsis, emergency department, long-term mortality, sepsis mortality, confounding by indication, antibiotic exposure
MeSH terms: Long Term Adverse Effects, Anti-Bacterial Agents, Emergency Medical Services, Emergency Service, Hospital, Female, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, United States, Outcome Assessment, Health Care, Sepsis, Time-to-Treatment

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ED door-to-antibiotic time and long-term mortality in sepsis.

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