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.
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.
Gaieski
David F
DF
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
Mikkelsen
Mark E
ME
Band
Roger A
RA
Pines
Jesse M
JM
Massone
Richard
R
Furia
Frances F
FF
Shofer
Frances S
FS
Goyal
Munish
M
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
D000900:Anti-Bacterial Agents