Quantifying the increased mortality associated with delayed antibiotics in pediatric sepsis

1. Administration of antibiotics beyond 330 minutes from emergency department arrival in pediatric patients with sepsis was associated with increased 3-day and 30-day sepsis-attributable mortality. 

Evidence Rating Level: 2 (Good)

Early administration of antibiotics has long been an important recommendation in the treatment of sepsis by various guidelines. However, a more detailed understanding of the association between time to antibiotic administration and pediatric sepsis outcomes, including clinical differences at multiple time points, has not been well established. This multicentre, retrospective cohort study therefore sought to investigate the association between time from sepsis identification to antibiotic administration with sepsis-attributable mortality. Pediatric patient presentations to the emergency department (ED) with recognized sepsis within 1 hour of arrival between January 1, 2017 and December 31, 2021 were identified to yield 19,515 cases. The primary exposure was the number of minutes to antibiotic administration while the primary and secondary outcomes were 3-day sepsis-attributable mortality and 30-day sepsis-attributable mortality, respectively. The odds of 3-day sepsis-attributable mortality increased for every 30-minute increment past 330 minutes for time to antibiotic administration (OR = 2.44, 95% CI = 1.28 to 4.62, P = 0.01). Compared to patients who received antibiotics earlier than 330 minutes, patients who received antibiotics later than 330 minutes had increased odds of sepsis-attributable mortality at 3 days (OR = 3.44, 95% CI = 1.20 to 9.93, P = 0.02) and 30 days (OR = 3.63, 95% CI = 1.59 to 8.30, P = 0.002) under adjusted analysis. Overall, this study found that among pediatric patients with sepsis presenting to the ED, sepsis-attributable mortality increased with antibiotic administration beyond 330 minutes from arrival and further supports the crucial importance of timely antibiotic therapy in pediatric sepsis. 

Click to read the study in JAMA Network Open

Image: PD

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