title: The Timing of Early Antibiotics and Hospital Mortality in Sepsis.
abstract: Prior sepsis studies evaluating antibiotic timing have shown mixed results.
  
  
  
  To evaluate the association between antibiotic timing and mortality among patients with sepsis receiving antibiotics within 6 hours of emergency department registration.
  
  
  
  Retrospective study of 35,000 randomly selected inpatients with sepsis treated at 21 emergency departments between 2010 and 2013 in Northern California. The primary exposure was antibiotics given within 6 hours of emergency department registration. The primary outcome was adjusted in-hospital mortality. We used detailed physiologic data to quantify severity of illness within 1 hour of registration and logistic regression to estimate the odds of hospital mortality based on antibiotic timing and patient factors.
  
  
  
  The median time to antibiotic administration was 2.1 hours (interquartile range, 1.4-3.1 h). The adjusted odds ratio for hospital mortality based on each hour of delay in antibiotics after registration was 1.09 (95% confidence interval [CI], 1.05-1.13) for each elapsed hour between registration and antibiotic administration. The increase in absolute mortality associated with an hour's delay in antibiotic administration was 0.3% (95% CI, 0.01-0.6%; P = 0.04) for sepsis, 0.4% (95% CI, 0.1-0.8%; P = 0.02) for severe sepsis, and 1.8% (95% CI, 0.8-3.0%; P = 0.001) for shock.
  
  
  
  In a large, contemporary, and multicenter sample of patients with sepsis in the emergency department, hourly delays in antibiotic administration were associated with increased odds of hospital mortality even among patients who received antibiotics within 6 hours. The odds increased within each sepsis severity strata, and the increased odds of mortality were greatest in septic shock.
authors.affiliation: 1 Kaiser Permanente Division of Research, Oakland, California.
authors.forename: Vincent X
authors.initials: VX
authors.lastname: Liu
authors.affiliation: 2 Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California.
authors.forename: Vikram
authors.initials: V
authors.lastname: Fielding-Singh
authors.affiliation: 1 Kaiser Permanente Division of Research, Oakland, California.
authors.forename: John D
authors.initials: JD
authors.lastname: Greene
authors.affiliation: 1 Kaiser Permanente Division of Research, Oakland, California.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Baker
authors.affiliation: 3 Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan.|4 Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
authors.affiliation: 5 Primary Care and Outcomes Research, Stanford University, Stanford, California.
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
authors.affiliation: 1 Kaiser Permanente Division of Research, Oakland, California.
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibacterial agents; sepsis; septic shock