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Cited by 117Sepsis Diagnosis and TreatmentAntibiotic Use and ResistanceAntibiotics Pharmacokinetics and Efficacy

A Systematic Review of the Effect of Delayed Appropriate Antibiotic Treatment on the Outcomes of Patients With Severe Bacterial Infections

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Zasowski, Evan J., Bassetti, Matteo, Blasi, Francesco, Goossens, Herman, Rello, Jordi, Sotgiu, Giovanni, Tavoschi, Lara, Arber, Mick R. +8 more·2020·Chest
DOI 10.1016/j.chest.2020.03.087
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Abstract

Background Patients with severe bacterial infections often experience delay in receiving appropriate treatment. Consolidated evidence of the impact of delayed appropriate treatment is needed to guide treatment and improve outcomes. Research question What is the impact of delayed appropriate antibacterial therapy on clinical outcomes in patients with severe bacterial infections? Study design and methods Literature searches of MEDLINE and Embase, conducted on July 24, 2018, identified studies published after 2007 reporting the impact of delayed appropriate therapy on clinical outcomes for hospitalized adult patients with bacterial infections. Where appropriate, results were pooled and analyzed with delayed therapy modeled three ways: delay vs no delay in receiving appropriate therapy; duration of delay; and inappropriate vs appropriate initial therapy. This article reports meta-analyses on the effect of delay and duration of delay. Results The eligibility criteria were met by 145 studies, of which 37 contributed data to analyses of effect of delay. Mortality was significantly lower in patients receiving appropriate therapy without delay compared with those experiencing delay (OR, 0.57; 95% CI, 0.45-0.72). Mortality was also lower in the no-delay group compared with the delay group in subgroups of studies reporting mortality at 20 to 30 days, during ICU stay, or in patients with bacteremia (OR, 0.57 [95% CI, 0.43-0.76]; OR, 0.47 [95% CI, 0.27-0.80]; and OR, 0.54 [95% CI, 0.40-0.75], respectively). No difference was found in time to appropriate therapy between those who died and those who survived (P = .09), but heterogeneity between studies was high. Interpretation Avoiding delayed appropriate therapy is essential to reduce mortality in patients with severe bacterial infections. Clinical trial registration PROSPERO; No.: CRD42018104669; URL: www.crd.york.ac.uk/prospero/.

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  • Approximately 47.3% of ICU patients with BSIs receive inadequate therapy within the first 24 h of symptom onset.

    “However, in some BSIs patients with less typical presentations delayed treatment is common: approximately 47.3% of ICU patients with BSIs receive inadequate therapy within the first 24 h of symptom onset [5–7].”

    From Early prediction of bloodstream infections in ICU patients using machine learning methods based on routine laboratory parameters (2025) · cites this paper as [7]

    The Introduction says many patients with severe bacterial infections experience delays in receiving appropriate antibiotics, and the Discussion reports delayed therapy in 27% of patients in its mortality analysis. Neither passage gives a 47.3% estimate for ICU patients with bloodstream infections or establishes a 24-hour window from symptom onset. (LLM, conf=0.88)

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Authors
Zasowski, E. J., Bassetti, M., Blasi, F., Goossens, H., Rello, J., Sotgiu, G., Tavoschi, L., Arber, M. R., McCool, R., Patterson, J. V., Longshaw, C. M., Lopes, S., Manissero, D., Nguyen, S. T., Tone, K., & Aliberti, S.
Affiliations
  • Touro University California (US)
  • Ospedale Policlinico San Martino (IT)
  • University of Milan (IT)
  • University of Antwerp (BE)
  • Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES)
  • University of Sassari (IT)
  • University of Pisa (IT)
  • University of York (GB)
  • University College London (GB)
Corresponding author
Aliberti, Stefano
ORCID
Venue
Chest
Publisher
Elsevier BV
Published
2020-09
Volume
158
Issue
3
Pages
929-938
ISSN
0012-3692 (ISSN-L)
DOI
10.1016/j.chest.2020.03.087
OpenAlex
W3027962356
Cited by
117
References
1
Citations by year
2026: 24 · 2025: 31 · 2024: 17 · 2023: 18 · 2022: 12 · 2021: 12 · 2020: 3
FWCI
1.64
Type
journal article
Language
en
Open access
Licence
Locations
  • CHEST Journal (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • Touro Scholar (Touro College) (submittedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, cc-by-nc-nd)
  • UnissResearch (Università degli Studi di Sassari) (submittedVersion)
Funders
University of York
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
Keywords
delayed antibiotic therapy, serious bacterial infection, mortality, bacteremia, ICU mortality, hospitalized adults
MeSH terms
Anti-Bacterial Agents, Bacterial Infections, Drug Administration Schedule, Humans, Time Factors

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