Antibiotic Timing in Severe Sepsis/Septic Shock

• Though the recent ProCESS trial has questioned the utility of central hemodynamic monitoring and protocol-based resuscitation, early antibiotic administration remains paramount in the care of patients with severe sepsis/septic shock.
• Retrospective studies have demonstrated that delays in antibiotic administration are associated with marked increases in hospital mortality.
• Notwithstanding, delays in antibiotic administration remain all too common.
• Ferrer et al, have just published the largest cohort to date analyzing the association of antibiotic timing to hospital mortality in patients with severe sepsis or septic shock.  The key findings include:
  • Retrospective cohort of 17,990 patients from the SSC database.
  • Hospital mortality rose linearly for each hour delay in antibiotic administration.
  • Odds ratio for hospital mortality increased from 1 to 1.52, as the delay increased from 0 to 6 hours after presentation.
• Key Point: Antibiotic timing matters!

References

Ferrer R, Martin-Loeches I, Phillips G, et al. 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. [epub ahead of print]