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Time to Antibiotics and the Outcome of Patients with Septic Shock: A Propensity Score Analysis

 Byuk Sung Ko  ;  Sung-Hyuk Choi  ;  Gu Hyun Kang  ;  Tae Gun Shin  ;  Kyuseok Kim  ;  You Hwan Jo  ;  Seung Mok Ryoo  ;  Youn-Jung Kim  ;  Yoo Seok Park  ;  Woon Yong Kwon  ;  Kap Su Han  ;  Han Sung Choi  ;  Sung Phil Chung  ;  Gil Joon Suh  ;  Hyunggoo Kang  ;  Tae Ho Lim  ;  Won Young Kim 
 AMERICAN JOURNAL OF MEDICINE, Vol.133(4) : 485-491.e4, 2020-04 
Journal Title
Issue Date
Aged ; Anti-Bacterial Agents / therapeutic use* ; Drug Administration Schedule ; Emergency Service, Hospital* ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Propensity Score ; Prospective Studies ; Shock, Septic / diagnosis ; Shock, Septic / drug therapy* ; Shock, Septic / mortality ; Time-to-Treatment
Antibacterial agents ; Outcome ; Propensity score ; Septic shock
Background: Current sepsis guidelines recommend administration of antibiotics within 1 hour of emergency department (ED) triage. However, the quality of the supporting evidence is moderate, and studies have shown mixed results regarding the association between antibiotic administration timing and outcomes in septic shock. We investigated to evaluate the association between antibiotic administration timing and in-hospital mortality in septic shock patients in the ED, using propensity score analysis. Methods: An observational study using a prospective, multicenter registry of septic shock, comprising data collected from 10 EDs, was conducted. Septic shock patients were included, and patients were divided into 4 groups by the interval from triage to first antibiotic administration: group 1 (≤1 hour; reference), 2 (1-2 hours), 3 (2-3 hours), and 4 (>3 hours). The primary endpoint was in-hospital mortality. After inverse probability of treatment weighting, the outcomes of the groups were compared. Results: A total of 2250 septic shock patients were included, and the median time to first antibiotic administration was 2.29 hours. The in-hospital mortality of groups 2 and 4 were significantly higher than those of group 1 (odds ratio [OR] 1.248; 95% confidence interval [CI], 1.053-1.478; P = .011; OR 1.419; 95% CI, 1.203-1.675; P < .001, respectively), but those of group 3 was not (OR 1.186; 95% CI, 0.999-1.408; P = .052). Subgroup analyses of patients (n = 2043) with appropriate antibiotics presented similar results. Conclusions: In patients with septic shock, rapid administration of antibiotics was generally associated with a decrease in in-hospital mortality, but no "every hour delay" was seen.
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1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
Yonsei Authors
Park, Yoo Seok(박유석) ORCID logo https://orcid.org/0000-0003-1543-4664
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
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