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Cited by 515Sepsis Diagnosis and TreatmentAntibiotics Pharmacokinetics and EfficacyNeonatal and Maternal Infections

Delayed Antimicrobial Therapy Increases Mortality and Organ Dysfunction Duration in Pediatric Sepsis*

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Weiss, Scott L., Fitzgerald, Julie C., Balamuth, Fran, Alpern, Elizabeth R., Lavelle, Jane, Chilutti, Marianne, Grundmeier, Robert, Nadkarni, Vinay M. +1 more·2014·Critical Care Medicine
DOI 10.1097/ccm.0000000000000509PMC PMC4213742
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Abstract

OBJECTIVES: Delayed antimicrobials are associated with poor outcomes in adult sepsis, but data relating antimicrobial timing to mortality and organ dysfunction in pediatric sepsis are limited. We sought to determine the impact of antimicrobial timing on mortality and organ dysfunction in pediatric patients with severe sepsis or septic shock. DESIGN: Retrospective observational study. SETTING: PICU at an academic medical center. PATIENTS: One hundred thirty patients treated for severe sepsis or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We determined if hourly delays from sepsis recognition to initial and first appropriate antimicrobial administration were associated with PICU mortality (primary outcome); ventilator-free, vasoactive-free, and organ failure-free days; and length of stay. Median time from sepsis recognition to initial antimicrobial administration was 140 minutes (interquartile range, 74-277 min) and to first appropriate antimicrobial was 177 minutes (90-550 min). An escalating risk of mortality was observed with each hour delay from sepsis recognition to antimicrobial administration, although this did not achieve significance until 3 hours. For patients with more than 3-hour delay to initial and first appropriate antimicrobials, the odds ratio for PICU mortality was 3.92 (95% CI, 1.27-12.06) and 3.59 (95% CI, 1.09-11.76), respectively. These associations persisted after adjustment for individual confounders and a propensity score analysis. After controlling for severity of illness, the odds ratio for PICU mortality increased to 4.84 (95% CI, 1.45-16.2) and 4.92 (95% CI, 1.30-18.58) for more than 3-hour delay to initial and first appropriate antimicrobials, respectively. Initial antimicrobial administration more than 3 hours was also associated with fewer organ failure-free days (16 [interquartile range, 1-23] vs 20 [interquartile range, 6-26]; p = 0.04). CONCLUSIONS: Delayed antimicrobial therapy was an independent risk factor for mortality and prolonged organ dysfunction in pediatric sepsis.

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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 [6]

    The Results report that 29 of 130 pediatric sepsis patients received inappropriate initial antimicrobial therapy, but do not give a rate for ICU patients with bloodstream infections. Searches for the 47.3% figure and inadequate therapy within 24 hours found no supporting passage in our copy. (LLM, conf=0.75)

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Authors
Weiss, S. L., Fitzgerald, J. C., Balamuth, F., Alpern, E. R., Lavelle, J., Chilutti, M., Grundmeier, R., Nadkarni, V. M., & Thomas, N. J.
Affiliations
Lurie Children's Hospital (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-11
Volume
42
Issue
11
Pages
2409-2417
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0000000000000509
PMC
PMC4213742
OpenAlex
W2327630244
Cited by
515
References
5
Citations by year
2026: 25 · 2025: 39 · 2024: 41 · 2023: 44 · 2022: 78 · 2021: 57 · 2020: 60 · 2019: 48 · 2018: 41 · 2017: 27 · 2016: 26 · 2015: 26 · 2014: 1
FWCI
20.20
Type
journal article
Language
en
Open access
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (K12HL109009)
  • National Institute of General Medical Sciences (L40 GM102883)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD047349)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
Keywords
pediatric sepsis, septic shock, mortality, organ dysfunction, organ failure, ICU mortality, length of hospital stay, sepsis recognition
MeSH terms
Academic Medical Centers, Adolescent, Anti-Bacterial Agents, Cause of Death, Child, Child, Preschool, Drug Administration Schedule, Female, Hospitals, Pediatric, Humans, Infant, Infusions, Intravenous, Male, Multiple Organ Failure, Retrospective Studies, Shock, Septic, Time Factors, Philadelphia, Intensive Care Units, Pediatric, Cohort Studies, Survival Rate, Multivariate Analysis, Logistic Models, Critical Illness, Hospital Mortality, Risk Assessment, Sepsis, Kaplan-Meier Estimate

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