Effect of Door-to-Antibiotic Time on Mortality of Patients with Sepsis in Emergency Department: A Prospective Cohort Study
-
Mohammad Jalili
,
Hasan Barzegari
,
Nasimi Pourtabatabaei
,
Amir Reza Honarmand
,
Majid Boreiri
,
Amir Mehrvarz
,
Zahra Ahmadinejad
Abstract
Sepsis constitutes an important cause of hospital admission with a high mortality rate. Appropriate antibiotic therapy is the cornerstone of therapy in patients with sepsis. Although numerous studies have recommended early antibiotic initiation in severe sepsis or septic shock stages of sepsis syndrome, its role in treatment of patients with sepsis who have not entered these stages remains to be investigated. The purpose of this study is to investigate the effect of door-to-antibiotic time in sepsis patients with various degrees of severity. This is a longitudinal prospective cohort study on adult patients admitted with sepsis to the emergency department. Sepsis was defined as presence of at least two criteria of systemic inflammatory response syndrome and procalcitonin levels ≥ 2μg/l. Severity of sepsis was determined using the APACHE II (Acute Physiology and Chronic Health Evaluation II) scoring system. Time to antibiotic administration was recorded and its relationship with mortality was assessed. A total of 145 patients were eligible for enrollment. The mean age was 60.4 years and the mean APACHE score was 13.7. The overall in-hospital mortality was 21.4%, and the mean length of stay in hospital was 211.9 hours. The mean door-to-antibiotic time for our patients was 104.4 minutes. Antibiotic administration time and mortality in patients with APACHE scores of 21 or higher (P=0.05) were significantly related; whereas such a relationship was not observed for patients with APACHE scores of 11- 20 (P=0.46). We observed early antibiotic initiation for patients in sepsis phase with higher severity scores was associated with significant improvement in survival rate.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of ChestPhysicians/Society of Critical Care Medicine. Chest 1992;101(6):1644–55.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29(7):1303–10.
Gaieski DF, Mikkelsen ME, Band RA, Pines JM, Massone R, Furia FF, Shofer FS, Goyal M. Impact of time to,antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy wasinitiated in the emergency department. Crit Care Med 2010;38(4):1045-53.
Sorbera LA. Procalcitonin as an effective biomarker for the diagnosis and prognosis of severe sepsis. Highlights from the 25th International Symposium on Intensive Care and Emergency Medicine. March 21-25, 2005, Brussels, Belgium. Drugs Today (Barc) 2005;41(5):253-6.
Liu XL, Du B, Pan JQ, Xu Y, Hua BL. Role of procalcitonin in the differentiation and surveillance of systemic inflammatory response syndrome. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2005;27(1):48-52.
Sibbald WJ, Vincent JL. Round table conference on clinical trials for the treatment of sepsis. Crit Care Med 1995;23(2):394.
Vallés J, Rello J, Ochagavía A, Garnacho J, Alcalá MA. Community-acquired bloodstream infection in critically ill adult patients: impact of shock and inappropriate antibiotic therapy on survival. Chest 2003;123(5):1615-24.
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34(6):1589-96.
Osih RB, McGregor JC, Rich SE, Moore AC, Furuno JP, Perencevich EN, Harris AD. Impact of Empiric Antibiotic Therapy on Outcomes in Patients with Pseudomonas aeruginosa Bacteremia. Antimicrob Agents Chemother 2007;51(3):839–44.
Ostman H, Sharma VK, Djekidel K, Haber A. Time to Antibiotic Administration and Outcome in Severe Sepsis and Septic Shock. Chest. 2007; 132(4_MeetingAbstracts):495 a http://journal.publications.chestnet.org/article.aspx?articleim d=1093525
Fulda GJ, Zubrow M, Dahanayake T, Mahoney D, Ellicott, A, Seckel M. Time to Antibiotic Administration and Outcome in Severe Sepsis and Septic Shock. Chest 2007;132(4_Meeting Abstracts): 495 http://journal.publications.chestnet.org/article.aspx?articlei d=1093524
Garnacho-Montero J, Aldabo-Pallas T, Garnacho-Montero C, Cayuela A, Jiménez R, Barroso S, Ortiz-Leyba C. Timing of adequate antibiotic therapy is a greater determinant of outcome than are TNF and IL-10 polymorphisms in patients with sepsis. Crit Care 2006;10(4):R111.
Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004;164(6):637-44.
Battleman DS, Callahan M, Thaler HT. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with communityacquired pneumonia: link between quality of care and resource utilization. Arch Intern Med 2002;162(6):682-8.
Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH.. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 2002;122(1):262-8.
Miner JR, Heegaard W, Mapes A, Biros M. Presentation, time to antibiotics, and mortality of patients with bacterial meningitis at an urban county medical center. J Emerg Med 2001;21(4):387-92.
Lepur D, Barsić B. Community-acquired bacterial meningitis in adults: antibiotic timing in disease course and outcome. Infection 2007;35(4):225-31.
Kim SH, Park WB, Lee CS, Kang CI, Bang JW, Kim HB, ,Kim NJ, Kim EC, Oh MD, Choe KW. Outcome of inappropriate empirical antibiotic therapy in patients with Staphylococcus aureus bacteraemia: analytical strategy using propensity scores. Clin Microbiol Infect 2006;12(1):13-21.
Marschall J, Agniel D, Fraser VJ, Doherty J, Warren DK. Gram-negative bacteraemia in non ICU patients: factorsassociated with inadequate antibiotic therapy and impact on outcomes. J Antimicrob Chemother 2008;61(6):1376-83.
Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005;49(9):3640-5.
Lodise TP, McKinnon PS, Swiderski L, Rybak MJ.,Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis 2003;36(11):1418-23.
Varpula M, Karlsson S, Parviainen I, Ruokonen E, Pettilä V; Finnsepsis Study Group. Community-acquired septic shock: early management and outcome in a nationwide study in Finland. Acta Anaesthesiol Scand 2007;51(10):1320-6.
Ferrer R, Artigas A, Suarez D, Palencia E, Levy MM, Arenzana A, Pérez XL, Sirvent JM; Edusepsis Study Group. Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study. Am J Respir Crit Care Med 2009; 180(9):861-6.
Zaragoza R, Artero A, Camarena JJ, Sancho S, González R, Nogueira JM. The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit. Clin Microbiol Infect 2003;9(5):412-8.
Lin MY, Weinstein RA, Hota B. Delay of active antimicrobial therapy and mortality among patients with bacteremia: impact of severe neutropenia. Antimicrob Agents Chemother 2008;52(9):3188-94.
Corona A, Bertolini G, Lipman J, Wilson AP, Singer M. Antibiotic use and impact on outcome from bacteraemic critical illness: the Bacteraemia Study in Intensive Care (BASIC). J Antimicrob Chemother 2010; 65(6):1276-85.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T,Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS,Zimmerman JL, Vincent JL. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008;34(1):17-60.
Garnacho-Montero J, Garcia-Garmendia JL, Barrero- Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003;31(12):2742-51.
Garnacho-Montero J, Ortiz-Leyba C, Herrera-Melero I, Aldabó-Pallás T, Cayuela-Dominguez A, Marquez-Vacaro JA, Carbajal-Guerrero J, Garcia-Garmendia JL. Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study. J Antimicrob Chemother 2008;61(2):436-41.
Artero A, Zaragoza R, Camarena JJ, Sancho S, González R, Nogueira JM. Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock. J Crit Care 2010;25(2):276-81.
MacArthur RD, Miller M, Albertson T, Panacek E, Johnson D, Teoh L, Barchuk W. Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial. Clin Infect Dis 2004;38(2):284-8.
Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet. 2005;365(9453):63-78.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348(16):1546-54.
| Files | ||
| Issue | Vol 51, No 7 (2013) | |
| Section | Articles | |
| Keywords | ||
| APACHE II Door-to-antibiotic time Mortality Sepsis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
