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The association between time to antibiotics and relevant clinical outcomes in emergency department patients with various stages of sepsis: a prospective multi-center study.

de Groot B, Ansems A, Gerling DH, Rijpsma D, van Amstel P, Linzel D, Kostense PJ, Jonker M, de Jonge E - Crit Care (2015)

Bottom Line: No association between time to antibiotics and surviving days outside the hospital or mortality was found.Only in PIRO group 1 to 7 was delayed administration of antibiotics (>3 hours) associated with an increase in surviving days outside the hospital at day 28 (hazard ratio: 1.46, 95% confidence interval: 1.05 to 2.02 after correction for potential confounders).In ED patients with mild to severe sepsis who received antibiotics within six hours after ED presentation, a reduction in time to antibiotics was not found to be associated with an improvement in relevant clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands. b.de_groot.SEH@lumc.nl.

ABSTRACT

Introduction: In early sepsis stages, optimal treatment could contribute to prevention of progression to severe sepsis. Therefore, we investigated if there was an association between time to antibiotics and relevant clinical outcomes in hospitalized emergency department (ED) patients with mild to severe sepsis stages.

Methods: This is a prospective multicenter study in three Dutch EDs. Patients were stratified into three categories of illness severity, as assessed by the predisposition, infection, response, and organ failure (PIRO) score: PIRO score 1 to 7, 8 to 14 and >14 points, reflected low, intermediate, and high illness severity, respectively. Consecutive hospitalized ED patients with a suspected infection who were treated with intravenous antibiotics were eligible to participate in the study. The primary outcome measure was the number of surviving days outside the hospital at day 28 which was used as an inverse measure of hospital length of stay (LOS). The secondary outcome measure was 28-day mortality, taking into account the time to mortality. Multivariable Cox regression analysis was used to estimate the association between time to antibiotics and the primary and secondary outcome measures corrected for confounders, including appropriateness of antibiotics and initial ED resuscitation, in three categories of illness severity.

Results: Of the 1,168 included patients, 112 died (10%), while 85% and 95% received antibiotics within three and six hours, respectively. No association between time to antibiotics and surviving days outside the hospital or mortality was found. Only in PIRO group 1 to 7 was delayed administration of antibiotics (>3 hours) associated with an increase in surviving days outside the hospital at day 28 (hazard ratio: 1.46, 95% confidence interval: 1.05 to 2.02 after correction for potential confounders).

Conclusions: In ED patients with mild to severe sepsis who received antibiotics within six hours after ED presentation, a reduction in time to antibiotics was not found to be associated with an improvement in relevant clinical outcomes.

No MeSH data available.


Related in: MedlinePlus

Patient inclusion and flow through study. Illness severity was expressed as Predisposition, Infection, Response, and Organ failure (PIRO) score.
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Fig1: Patient inclusion and flow through study. Illness severity was expressed as Predisposition, Infection, Response, and Organ failure (PIRO) score.

Mentions: Figure 1 shows a diagram of patient inclusion and flow through the study. A total of 1,168 patients were included: 413 patients in PIRO category 1 to 7, 532 patients in PIRO category 8 to 14, and 223 patients in PIRO category >14. Patient characteristics are shown in Table 1 as a function of illness severity. Time to antibiotics decreased with increasing PIRO category. However, within one PIRO category there was no association between PIRO score and time to antibiotics (minutes); regression coefficients (CI) for linear regression were −12.38 (−35.05 to 10.30) for PIRO 1 to 7, −10.21 (−25.90 to 5.48) for PIRO 8 to 14 and 8.44 (−12.36 to 29.25) for PIRO >14.Figure 1


The association between time to antibiotics and relevant clinical outcomes in emergency department patients with various stages of sepsis: a prospective multi-center study.

de Groot B, Ansems A, Gerling DH, Rijpsma D, van Amstel P, Linzel D, Kostense PJ, Jonker M, de Jonge E - Crit Care (2015)

Patient inclusion and flow through study. Illness severity was expressed as Predisposition, Infection, Response, and Organ failure (PIRO) score.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4440486&req=5

Fig1: Patient inclusion and flow through study. Illness severity was expressed as Predisposition, Infection, Response, and Organ failure (PIRO) score.
Mentions: Figure 1 shows a diagram of patient inclusion and flow through the study. A total of 1,168 patients were included: 413 patients in PIRO category 1 to 7, 532 patients in PIRO category 8 to 14, and 223 patients in PIRO category >14. Patient characteristics are shown in Table 1 as a function of illness severity. Time to antibiotics decreased with increasing PIRO category. However, within one PIRO category there was no association between PIRO score and time to antibiotics (minutes); regression coefficients (CI) for linear regression were −12.38 (−35.05 to 10.30) for PIRO 1 to 7, −10.21 (−25.90 to 5.48) for PIRO 8 to 14 and 8.44 (−12.36 to 29.25) for PIRO >14.Figure 1

Bottom Line: No association between time to antibiotics and surviving days outside the hospital or mortality was found.Only in PIRO group 1 to 7 was delayed administration of antibiotics (>3 hours) associated with an increase in surviving days outside the hospital at day 28 (hazard ratio: 1.46, 95% confidence interval: 1.05 to 2.02 after correction for potential confounders).In ED patients with mild to severe sepsis who received antibiotics within six hours after ED presentation, a reduction in time to antibiotics was not found to be associated with an improvement in relevant clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands. b.de_groot.SEH@lumc.nl.

ABSTRACT

Introduction: In early sepsis stages, optimal treatment could contribute to prevention of progression to severe sepsis. Therefore, we investigated if there was an association between time to antibiotics and relevant clinical outcomes in hospitalized emergency department (ED) patients with mild to severe sepsis stages.

Methods: This is a prospective multicenter study in three Dutch EDs. Patients were stratified into three categories of illness severity, as assessed by the predisposition, infection, response, and organ failure (PIRO) score: PIRO score 1 to 7, 8 to 14 and >14 points, reflected low, intermediate, and high illness severity, respectively. Consecutive hospitalized ED patients with a suspected infection who were treated with intravenous antibiotics were eligible to participate in the study. The primary outcome measure was the number of surviving days outside the hospital at day 28 which was used as an inverse measure of hospital length of stay (LOS). The secondary outcome measure was 28-day mortality, taking into account the time to mortality. Multivariable Cox regression analysis was used to estimate the association between time to antibiotics and the primary and secondary outcome measures corrected for confounders, including appropriateness of antibiotics and initial ED resuscitation, in three categories of illness severity.

Results: Of the 1,168 included patients, 112 died (10%), while 85% and 95% received antibiotics within three and six hours, respectively. No association between time to antibiotics and surviving days outside the hospital or mortality was found. Only in PIRO group 1 to 7 was delayed administration of antibiotics (>3 hours) associated with an increase in surviving days outside the hospital at day 28 (hazard ratio: 1.46, 95% confidence interval: 1.05 to 2.02 after correction for potential confounders).

Conclusions: In ED patients with mild to severe sepsis who received antibiotics within six hours after ED presentation, a reduction in time to antibiotics was not found to be associated with an improvement in relevant clinical outcomes.

No MeSH data available.


Related in: MedlinePlus