title: Analysis of Race and Time to Antibiotics Among Patients with Severe Sepsis or Septic Shock.
abstract: The objective of this study is to investigate potential racial disparities in time to antibiotics among patients presenting to the emergency department (ED) with severe sepsis or septic shock.
  
  
  
  This was a retrospective observational study of adults >18 years with severe sepsis or septic shock presenting to a large, urban, academic ED and admitted to the ICU from 10/2005 to 2/2012. Time to antibiotic data was abstracted by ICU research staff; other data were abstracted by blinded trained research assistants using standardized abstraction forms. Time from ED arrival to antibiotics was compared in white vs. non-white patients using cumulative events curves followed by Cox proportional hazards regression, controlling for age, gender, ethnicity, source of infection, and SOFA score.
  
  
  
  Seven hundred sixty-eight patients were included; 19.5 % (n = 150) were non-white. Median minutes to antibiotics was 131 in white patients vs. 158 in non-white patients (p = 0.03, log-rank test). The unadjusted hazard ratio for non-white patients was 0.82 (95 %CI 0.58-0.98). After adjustment, the hazard ratio for race was not significant (0.90, 95 %CI 0.73-1.10).
  
  
  
  In a single-center sample of patients with severe sepsis or septic shock, adjustment for factors including age and infectious source eliminated the difference in time to antibiotics by race. Further research should investigate disparities in sepsis care between hospitals with differing patient populations.
authors.affiliation: Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick Street, 2nd floor, Providence, RI, 02903, USA. Tracy_Madsen@brown.edu.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Madsen
authors.affiliation: Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick Street, 2nd floor, Providence, RI, 02903, USA.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Napoli
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012237:Rhode Island; D018805:Sepsis / Q000188:drug therapy / Q000208:ethnology*; D012772:Shock, Septic / Q000188:drug therapy / Q000208:ethnology*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Infection; Race; Sepsis; Septic shock