title: Effects of antibiotic administration delay and inadequacy upon the survival of septic shock patients.
abstract: OBJECTIVE
  To assess how antibiotic administration delay and inadequacy influence survival in septic shock patients.
  
  
  METHODS
  A prospective, observational cohort study was carried out between September 2005 and September 2010.
  
  
  METHODS
  Patients admitted to the ICU of a third level hospital.
  
  
  METHODS
  A total of 342 septic shock patients
  
  
  METHODS
  None
  
  
  METHODS
  The time to antibiotic administration (difference between septic shock presentation and first administered dose of antibiotic) and its adequacy (in vitro susceptibility testing of isolated pathogens) were determined.
  
  
  RESULTS
  ICU and hospital mortality were 26.4% and 33.5%, respectively. The median delay to administration of the first antibiotic dose was 1.7h. Deceased patients received antibiotics significantly later than survivors (1.3±14.5h vs. 5.8±18.02h; P=.001). Percentage drug inadequacy was 12%. Those patients who received inadequate antibiotics had significantly higher mortality rates (33.8% vs. 51.2%; P=.03). The coexistence of treatment delay and inadequacy was associated to lower survival rates.
  
  
  CONCLUSIONS
  Both antibiotic administration delay and inadequacy exert deleterious effects upon the survival of septic shock patients, independently of their characteristics or severity.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España. Electronic address: bsuberviola@yahoo.es.
authors.forename: B
authors.initials: B
authors.lastname: Suberviola Cañas
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
authors.forename: R
authors.initials: R
authors.lastname: Jáuregui
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Ballesteros
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
authors.forename: O
authors.initials: O
authors.lastname: Leizaola
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
authors.forename: A
authors.initials: A
authors.lastname: González-Castro
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
authors.forename: Á
authors.initials: Á
authors.lastname: Castellanos-Ortega
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000401:mortality; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Antibióticos; Delay; Inadecuación; Inadequacy; Mortalidad; Mortality; Retraso; Septic shock; Shock séptico