title: Prognostic value of timing of antibiotic administration in patients with septic shock treated with early quantitative resuscitation.
abstract: BACKGROUND
  The Surviving Sepsis Campaign recommends initiating broad-spectrum antibiotic treatment within 1 hour of septic shock recognition. However, there is controversy regarding this owing to contradictory studies. This study investigated the relationship between the antibiotic administration interval and 28-day mortality in septic shock patients treated with an early quantitative resuscitation protocol in an emergency department (ED).
  
  
  METHODS
  715 consecutive septic shock patients were prospectively collected from January 2010 to December 2012. Of these, 426 patients developed shock at or after initial assessment, and the time of initial antibiotic administration was recorded. The primary outcome was 28-day mortality.
  
  
  RESULTS
  The median antibiotic administration interval was 91.5 (47.0-158.0) minutes, and the 28-day mortality was 20.0%. Mortality did not change with hourly delays in antibiotic administration up to 5 hours after shock recognition: 1 hour (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.45-1.45), 2 hours (OR: 0.72, 95% CI: 0.40-1.29) and 3 hours (OR: 0.61, 95% CI: 0.30-1.25). However, inability to achieve early resuscitation goals (OR: 1.94, 95% CI: 1.07-3.51), sequential organ failure assessment score (OR: 1.30, 95% CI: 1.17-1.44) and lactic acid concentration (OR: 1.66, 95% CI: 1.11-2.49) were significantly associated with an increased risk of 28-day mortality.
  
  
  CONCLUSIONS
  Among septic shock patients who underwent early quantitative resuscitation in an ED, mortality did not increase with hourly delays in antibiotic administration. These data call into question the strength of the association between hourly delays in antibiotic administration and mortality in septic shock patients.
authors: Department of Emergency Medicine (SMR, WYK, CHS, DWS, JHL, BJO, KSL), University of Ulsan College of Medicine, Asan Medical Center, Seoul, and Department of Ophthalmology (JWK), Chosun University College of Medicine, Gwangju Korea.
authors: Seung Mok
authors: SM
authors: Ryoo
authors: Won Young
authors: WY
authors: Kim
authors: Chang Hwan
authors: CH
authors: Sohn
authors: Dong Woo
authors: DW
authors: Seo
authors: Jae Woong
authors: JW
authors: Koh
authors: Bum Jin
authors: BJ
authors: Oh
authors: Kyoung Soo
authors: KS
authors: Lim
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D012772:Shock, Septic / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents