Written by Clay Smith
Spoon Feed
Timely appropriate antibiotic therapy was associated with lower mortality.
Why does this matter?
Empiric antibiotic therapy, given early, is a keystone of sepsis management. However, studies have shown conflicting results with regard to the impact of delayed antibiotic administration. What does a compendium of the evidence show?
Delay measured in days? Yeah, that’s bad…
This was a systematic review of 37 studies done after 2007, in hospitalized patients who had severe bacterial illnesses. Most were retrospective, and heterogeneity was very high. The definition of “delayed” ranged from >1 hour to >5 days among studies. They meta-analyzed 19 of the studies and found that no delay in antibiotic administration was associated with a marked reduction in odds of mortality, OR 0.57 (95% CI 0.45-0.72). This study does not inform the debate about immediate (<1 hour) vs early (<3 hour) antibiotics handed down in recent sepsis mandates. We will discuss that tomorrow. What it tells us is that the earlier we can start appropriate antibiotic therapy in patients with suspected (or confirmed) severe bacterial illnesses, the lower the mortality for our patients.
Source
A systematic review of the effect of delayed appropriate antibiotic treatment on the outcomes of patients with severe bacterial infections. Chest. 2020 May 21. pii: S0012-3692(20)31497-5. doi: 10.1016/j.chest.2020.03.087. [Epub ahead of print]
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It might be more plausible to conclude that "patients who have obvious clinical infection on initial presentation do better than those whose diagnosis is more obscure or complex and thus takes hours (or days..?) to sort out".