A Critical Analysis of the Literature on Time-to-Antibiotics in Suspected Sepsis.

The Journal of Infectious Diseases
Jeremy WeinbergerMichael Klompas

Abstract

The Surviving Sepsis Campaign recommends immediate antibiotics for all patients with suspected sepsis and septic shock, ideally within 1 hour of recognition. Immediate antibiotic treatment is lifesaving for some patients, but a substantial fraction of patients initially diagnosed with sepsis have noninfectious conditions. Aggressive time-to-antibiotic targets risk promoting antibiotic overuse and antibiotic-associated harms for this subset of the population. An accurate understanding of the precise relationship between time-to-antibiotics and mortality for patients with possible sepsis is therefore critical to finding the best balance between assuring immediate antibiotics for those patients who truly need them versus allowing clinicians some time for rapid investigation to minimize the risk of overtreatment and antibiotic-associated harms for patients who are not infected. More than 30 papers have been published assessing the relationship between time-to-antibiotics and outcomes, almost all of which are observational cohort studies. Most report significant associations but all have important limitations. Key limitations include focusing just on the sickest subset of patients (only patients requiring intensive care and/or patie...Continue Reading

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Citations

Jul 22, 2020·The Journal of Infectious Diseases·Jeffrey R StrichHenry Masur
Jul 22, 2020·The Journal of Infectious Diseases·Edward J Septimus
Apr 16, 2021·Critical Care Medicine·Chanu Rhee, Emily L Heil
Apr 26, 2021·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·Gina K ThomsonKenneth S Thomson
Apr 20, 2021·Annals of Internal Medicine·Michael Klompas, Chanu Rhee
May 26, 2021·Clinics in Perinatology·Joseph B Cantey, John H Lee
Aug 28, 2021·Critical Care : the Official Journal of the Critical Care Forum·Michael S NiedermanGirish B Nair

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