title: INITIAT-E.D.: Impact of timing of INITIation of Antibiotic Therapy on mortality of patients presenting to an Emergency Department with sepsis.
abstract: OBJECTIVE
  To analyse the association between time from triage to administration of initial antibiotics and mortality in all patients presenting with sepsis to a tertiary hospital ED.
  
  
  METHODS
  A retrospective review of patients presenting to the ED with sepsis from January to December 2012 was conducted at Flinders Medical Centre, South Australia. Outcome measures were: time elapsed from triage to administration of initial antibiotic therapy and in-hospital mortality.
  
  
  RESULTS
  A total of 220 patients presented with sepsis, comprising 102 cases of uncomplicated sepsis and 118 severe sepsis. The median time to antibiotic administration was 3.5 h (interquartile range [IQR] 1.7-6.6) and in-hospital mortality was 28.6% (95% CI 22.6-34.6%). There was no association observed between delays to antibiotics and mortality in the total patient population. When stratified by presenting severity, patients with severe sepsis demonstrated a trend towards increased mortality when delays to antibiotics exceeded 6 h from triage (HR = 2.25, 95% CI 0.91-5.59, P = 0.08) in comparison with <1 h. Significant delays to antibiotic administration occurred when initial agents were charted as a 'regular medicine' (9.4 h, IQR 5.1-16.6) in comparison with a 'once only order' (3.4 h, IQR 1.7-6.7), P < 0.001.
  
  
  CONCLUSIONS
  Early administration of antibiotics specifically in patients with severe sepsis might be beneficial. Further studies within the ED are warranted to establish the effect of delayed antibiotics in a generalised sepsis cohort.
authors.affiliation: SA Pharmacy, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Alice
authors.initials: A
authors.lastname: Wisdom
authors.affiliation: SA Pharmacy, Flinders Medical Centre, Adelaide, South Australia, Australia.|School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Vaughn
authors.initials: V
authors.lastname: Eaton
authors.affiliation: School of Medicine, Flinders University, Adelaide, South Australia, Australia.|Department of Microbiology and Infectious Diseases, SA Pathology, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Gordon
authors.affiliation: School of Medicine, Flinders University, Adelaide, South Australia, Australia.|Department of Microbiology and Infectious Diseases, SA Pathology, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Santhosh
authors.initials: S
authors.lastname: Daniel
authors.affiliation: Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Woodman
authors.affiliation: SA Pharmacy, Flinders Medical Centre, Adelaide, South Australia, Australia.|School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Cameron
authors.initials: C
authors.lastname: Phillips
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy; D013021:South Australia; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D010456:Peptides, Cyclic; C476162:kapakahine E
keywords: antibacterial agents; emergency department; mortality; sepsis; time factors