Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol.

Puskarich, Michael A.; Trzeciak, Stephen; Shapiro, Nathan I.; Arnold, Ryan C.; Horton, James M.; Studnek, Jonathan R.; Kline, Jeffrey A.; Jones, Alan E.

doi:10.1097/ccm.0b013e31821e87ab

Cited by 376Sepsis Diagnosis and TreatmentAntibiotics Pharmacokinetics and EfficacyAbdominal Surgery and Complications

Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol.

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Puskarich, Michael A., Trzeciak, Stephen, Shapiro, Nathan I., Arnold, Ryan C., Horton, James M., Studnek, Jonathan R., Kline, Jeffrey A., Jones, Alan E.·2011·Critical Care Medicine

DOI 10.1097/ccm.0b013e31821e87abPMC PMC3158284

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Abstract

OBJECTIVE: We sought to determine the association between time to initial antibiotics and mortality of patients with septic shock treated with an emergency department-based early resuscitation protocol. DESIGN: Preplanned analysis of a multicenter randomized controlled trial of early sepsis resuscitation. SETTING: Three urban U.S. emergency departments. PATIENTS: Adult patients with septic shock. INTERVENTIONS: A quantitative resuscitation protocol in the emergency department targeting three physiological variables: central venous pressure, mean arterial pressure, and either central venous oxygen saturation or lactate clearance. The study protocol was continued until all end points were achieved or a maximum of 6 hrs. MEASUREMENTS AND MAIN RESULTS: Data on patients who received an initial dose of antibiotics after presentation to the emergency department were categorized based on both time from triage and time from shock recognition to initiation of antibiotics. The primary outcome was inhospital mortality. Of 291 included patients, mortality did not change with hourly delays in antibiotic administration up to 6 hrs after triage: 1 hr (odds ratio [OR], 1.2; 0.6-2.5), 2 hrs (OR, 0.71; 0.4-1.3), 3 hrs (OR, 0.59; 0.3-1.3). Mortality was significantly increased in patients who received initial antibiotics after shock recognition (n = 172 [59%]) compared with before shock recognition (OR, 2.4; 1.1-4.5); however, among patients who received antibiotics after shock recognition, mortality did not change with hourly delays in antibiotic administration. CONCLUSION: In this large, prospective study of emergency department patients with septic shock, we found no increase in mortality with each hour delay to administration of antibiotics after triage. However, delay in antibiotics until after shock recognition was associated with increased mortality.

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Other studies did not observe an association between antimicrobial timing and mortality.
“Other studies, however, did not observe an association between antimicrobial timing and mortality [112–117].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [115]

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Authors: Puskarich, M. A., Trzeciak, S., Shapiro, N. I., Arnold, R. C., Horton, J. M., Studnek, J. R., Kline, J. A., & Jones, A. E.
Affiliations: Beth Israel Deaconess Medical Center (US)
ORCID: Puskarich, Michael A.
Trzeciak, Stephen
Shapiro, Nathan I.
Studnek, Jonathan R.
Kline, Jeffrey A.
Jones, Alan E.
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2011-09
Volume: 39
Issue: 9
Pages: 2066-2071
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/ccm.0b013e31821e87ab
PMC: PMC3158284
OpenAlex: W2165760729
Semantic Scholar: 52aaa785ac1f94a568f0adca8a551898395dcaf1
Cited by: 376
References: 19
Citations by year: 2026: 7 · 2025: 15 · 2024: 16 · 2023: 18 · 2022: 13 · 2021: 28 · 2020: 34 · 2019: 27 · 2018: 20 · 2017: 37 · 2016: 34 · 2015: 35 · 2014: 43 · 2013: 30 · 2012: 17
FWCI: 22.17
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Critical Care Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
IUScholarWorks (Indiana University) (submittedVersion)
Purdue University Indianapolis (Indiana University) (submittedVersion)
Funders: American Heart Association
National Institutes of Health
National Heart, Lung, and Blood Institute (R01HL091757, HL091757)
National Institute of General Medical Sciences (P50GM076659, K23GM076652, GM076659, K23GM083211, GM083211)
Topics: Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
Keywords: septic shock, timing of antibiotic administration, sepsis mortality, shock recognition, emergency department, central venous pressure, lactate clearance, central venous oxygen saturation, mean arterial pressure
MeSH terms: Aged, Anti-Bacterial Agents, Blood Pressure, Central Venous Pressure, Clinical Protocols, Emergency Service, Hospital, Female, Humans, Lactates, Male, Middle Aged, Oxygen, Resuscitation, Shock, Septic, Time Factors, Treatment Outcome, Hospital Mortality

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Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol.

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