title: Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department.
abstract: OBJECTIVE
  To study the association between time to antibiotic administration and survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department.
  
  
  METHODS
  Single-center cohort study.
  
  
  METHODS
  The emergency department of an academic tertiary care center from 2005 through 2006.
  
  
  METHODS
  Two hundred sixty-one patients undergoing early goal-directed therapy.
  
  
  METHODS
  None.
  
  
  RESULTS
  Effects of different time cutoffs from triage to antibiotic administration, qualification for early goal-directed therapy to antibiotic administration, triage to appropriate antibiotic administration, and qualification for early goal-directed therapy to appropriate antibiotic administration on in-hospital mortality were examined. The mean age of the 261 patients was 59 +/- 16 yrs; 41% were female. In-hospital mortality was 31%. Median time from triage to antibiotics was 119 mins (interquartile range, 76-192 mins) and from qualification to antibiotics was 42 mins (interquartile range, 0-93 mins). There was no significant association between time from triage or time from qualification for early goal-directed therapy to antibiotics and mortality when assessed at different hourly cutoffs. When analyzed for time from triage to appropriate antibiotics, there was a significant association at the <1 hr (mortality 19.5 vs. 33.2%; odds ratio, 0.30 [95% confidence interval, 0.11-0.83]; p = .02) time cutoff; similarly, for time from qualification for early goal-directed therapy to appropriate antibiotics, a significant association was seen at the < or =1 hr (mortality 25.0 vs. 38.5%; odds ratio, 0.50 [95% confidence interval, 0.27-0.92]; p = .03) time cutoff.
  
  
  CONCLUSIONS
  Elapsed times from triage and qualification for early goal-directed therapy to administration of appropriate antimicrobials are primary determinants of mortality in patients with severe sepsis and septic shock treated with early goal-directed therapy.
authors.affiliation: Department of Emergency Medicine, Division of Pulmonary, Allergy, and Critical Care, the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA. gaieskid@uphs.upenn.edu
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.forename: Roger A
authors.initials: RA
authors.lastname: Band
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.forename: Richard
authors.initials: R
authors.lastname: Massone
authors.forename: Frances F
authors.initials: FF
authors.lastname: Furia
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Munish
authors.initials: M
authors.lastname: Goyal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002985:Clinical Protocols / Q000592:standards; D015331:Cohort Studies; D016001:Confidence Intervals; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents