Let’s check out another in the  top ten articles presented at the recent AAP NCE in San Diego. This study examined the relationship between time to antibiotics and morbidity and mortality in pediatric sepsis.

Delayed Antimicrobial Therapy Increases Mortality and Organ Dysfunction Duration in Pediatric Sepsis

Weiss, Scott L. MD, Fitzgerald, Julie C. MD, PhD, Balamuth, Fran MD, PhD, Alpern, Elizabeth R. MD, MSCE, Lavelle, Jane MD, Chilutti, Marianne MS, Grundmeier, Robert MD, Nadkarni, Vinay M. MD, MS, Thomas, Neal J. MD, MSc. Critical Care Medicine, 2014
Links PubMed Critical Care Medicine

The bottom line

Early administration of antibiotics in sepsis reduces mortality.

What they did

The authors performed a retrospective observational study of 130 children treated for severe sepsis or septic shock. Some definitions:

  • Severe sepsis: Sepsis-induced organ dysfunction or tissue hypoperfusion (hypotension, elevated lactate, or decreased urine output)
  • Septic shock: Severe sepsis plus persistent hypotension despite the administration of IV fluids

 

They reviewed data for several outcomes related to sepsis mortality and morbidity and noted the following:

  • Median time to first antibiotics was 140 minutes and 177 minutes for appropriate antibiotic
  • Each one hour delay from sepsis recognition to antimicrobial administration increased mortality. It was statistically significant at >3 hours with mortality OR=3.92 (95% CI, 1.27-12.06) for initial antibiotic and 3.59 (95% CI, 1.09-11.76) for appropriate antibiotic
  • Naturally, odds of mortality were greater when illness severity was favored in – OR=4.84 (95% CI, 1.45-16.2) and 4.92 (95% CI, 1.30-18.58) for more than 3-hour delay to initial and first appropriate antimicrobials, respectively
  • Finally, delaying antibiotics >3 hours was associated with a longer period of organ-failure (16 days for <3 hours vs 20 days for > 3 hours, p = 0.04).

What you can do

  • Even if you are only somewhat suspicious for sepsis GIVE ANTIBIOTICS ASAP!
  • Consider broad spectrum agents appropriate for the patient population including gram positive and negative coverage (ceftriaxone + vancomycin for instance)
  • Even if you aren’t sure that it’s sepsis – or may just SIRS – GIVE ANTIBIOTICS ASAP!
  • When taking a referral from an outside hospital assure that antibiotics are given prior to transfer if at all possible