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

for the Korean Shock Society (KoSS) Investigators

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalAmerican Journal of Medicine
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Propensity Score
Septic Shock
Anti-Bacterial Agents
Hospital Mortality
Triage
Odds Ratio
Confidence Intervals
Hospital Emergency Service
Observational Studies
Registries
Sepsis
Guidelines

Keywords

  • Antibacterial agents
  • Outcome
  • Propensity score
  • Septic shock

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Time to Antibiotics and the Outcome of Patients with Septic Shock : A Propensity Score Analysis. / for the Korean Shock Society (KoSS) Investigators.

In: American Journal of Medicine, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Time to Antibiotics and the Outcome of Patients with Septic Shock: A Propensity Score Analysis",
abstract = "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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author = "{for the Korean Shock Society (KoSS) Investigators} and Ko, {Byuk Sung} and Choi, {Sung Hyuk} and Kang, {Gu Hyun} and Shin, {Tae Gun} and Kyuseok Kim and Jo, {You Hwan} and Ryoo, {Seung Mok} and Kim, {Youn Jung} and Park, {Yoo Seok} and Kwon, {Woon Yong} and Han, {Kap Su} and Choi, {Han Sung} and Chung, {Sung Phil} and Suh, {Gil Joon} and Hyunggoo Kang and Lim, {Tae Ho} and Kim, {Won Young}",
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T1 - Time to Antibiotics and the Outcome of Patients with Septic Shock

T2 - A Propensity Score Analysis

AU - for the Korean Shock Society (KoSS) Investigators

AU - Ko, Byuk Sung

AU - Choi, Sung Hyuk

AU - Kang, Gu Hyun

AU - Shin, Tae Gun

AU - Kim, Kyuseok

AU - Jo, You Hwan

AU - Ryoo, Seung Mok

AU - Kim, Youn Jung

AU - Park, Yoo Seok

AU - Kwon, Woon Yong

AU - Han, Kap Su

AU - Choi, Han Sung

AU - Chung, Sung Phil

AU - Suh, Gil Joon

AU - Kang, Hyunggoo

AU - Lim, Tae Ho

AU - Kim, Won Young

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Antibacterial agents

KW - Outcome

KW - Propensity score

KW - Septic shock

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