Optimal Time to Antibiotics in Pediatric Sepsis?
July 16, 2024
Written by Joshua Belfer
Spoon Feed
In a cohort of septic children, delays in antibiotic administration 330 minutes or longer from arrival to the emergency department led to an increase in mortality.
Long delays in antibiotics affect mortality
Using a retrospective cohort of over 19,000 pediatric patients with sepsis from 51 hospitals, this study found that the time to antibiotic administration at which 3-day sepsis-attributable mortality increased was 330 minutes. The mortality rate was 0.5% for patients receiving antibiotics prior to 330 minutes, compared to 1.2% for those receiving 330 minutes or later. This trend held true for 30-day mortality as well. For every 30 minute interval after 330 minutes, the odds of mortality increased (OR 2.44).
Subgroup analysis showed that bacteremia and lactate greater than 4 mmol/L (36 mg/dL) were also associated with increased odds of sepsis-attributable mortality. Interestingly, for those patients with bacteremia who received an antibiotic within 180 minutes of arrival to the ED, the time to antibiotic administration at which mortality changed from decreasing to increasing was 90 minutes, although this was not statistically significant.
As with all sepsis studies, the potential of confounders must be considered. The authors suggest that the overall low mortality rate, along with few patients receiving antibiotics very late after ED presentation, may have impacted the calculated inflection point in the analysis.
How will this change my practice?
Sepsis is of course one, if not the, biggest focus of study in pediatric emergency medicine. The 2020 Surviving Sepsis guidelines reinforced the importance of prompt antimicrobial therapy once sepsis is suspected. While this study establishes a potential time period after which antibiotics will not reduce mortality, the important part remains unchanged: if you suspect sepsis, treat with antibiotics right away!
Source
Delays to Antibiotics in the Emergency Department and Risk of Mortality in Children With Sepsis. JAMA Netw Open. 2024 Jun 3;7(6):e2413955. doi: 10.1001/jamanetworkopen.2024.13955. PMID: 38837160; PMCID: PMC11154154.