Because sepsis represents a dysregulated immune response to infection, antibiotics
are a cornerstone to its management. Clinicians face two key practical questions related
to antibiotics in suspected sepsis: When should antibiotic(s) be started; and what
antibiotics should be given? Several well-conducted observational studies have reported
poorer outcomes with delayed antibiotic administration in sepsis.
1
,
2
,
3
In an early retrospective study of > 2,000 hospitalized patients, survival decreased
by 7.6% for every hour delay in antibiotic administration from hypotension onset.
1
Similarly, among ED patients with severe sepsis, time to first antimicrobial agent
has been associated with increased risk of progression to septic shock.
3
Finally, using prospectively collected data for the Surviving Sepsis Campaign, investigators
showed that the probability of death increased with each hour delay in 17,990 patients
across 165 ICUs worldwide, irrespective of the number of organ failures.
2
Definition of time zero has varied across studies; nonetheless, the Surviving Sepsis
Campaign gave a strong recommendation based on moderate-quality data to administer
IV antimicrobial agents as soon as possible after recognition and within 1 h for both
sepsis and septic shock.
4
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References
- Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.Crit Care Med. 2006; 34: 1589-1596
- Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program.Crit Care Med. 2014; 42: 1749-1755
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- The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001-2010.Am J Infect Control. 2014; 42: 1028-1032
- Importation, antibiotics, and Clostridium difficile infection in veteran long-term care: a multilevel case-control study.Ann Intern Med. 2016; 164: 787-794
- Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection.Clin Infect Dis. 2011; 53: 42-48
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Article Info
Footnotes
FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.
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Copyright
© 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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- POINT: Should Broad-Spectrum Antibiotics Be Routinely Administered to All Patients With Sepsis as Soon as Possible? YesCHESTVol. 156Issue 4
- In BriefSepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.1 It affects millions of people worldwide annually, with a mortality ranging from 25% to 50%.2 Significant improvements in patient outcomes have resulted from early identification and appropriate management in the initial hours following development of sepsis. Evidence-based guidelines currently recommend empiric broad-spectrum antibiotics with one or more antimicrobial agents within 1 h for patients with sepsis or septic shock, a strong recommendation with moderate quality of evidence.
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