Time to antibiotic initiation and mortality in severe sepsis and septic shock

Here's even more evidence from the Surviving Sepsis Campaign:

MEASUREMENTS AND MAIN RESULTS:

A total of 17,990 patients received antibiotics after sepsis identification and were included in the analysis. In-hospital mortality was 29.7% for the cohort as a whole. There was a statically significant increase in the probability of death associated with the number of hours of delay for first antibiotic administration. Hospital mortality adjusted for severity (sepsis severity score), ICU admission source (emergency department, ward, vs ICU), and geographic region increased steadily after 1 hour of time to antibiotic administration. Results were similar in patients with severe sepsis and septic shock, regardless of the number of organ failure.

CONCLUSIONS:

The results of the analysis of this large population of patients with severe sepsis and septic shock demonstrate that delay in first antibiotic administration was associated with increased in-hospital mortality. In addition, there was a linear increase in the risk of mortality for each hour delay in antibiotic administration. These results underscore the importance of early identification and treatment of septic patients in the hospital setting.

As the blog author at Intensive care medicine worth knowing pointed out, restrictive strategies for initial antibiotic decisions are losing their place in antibiotic stewardship. De-escalation is where it's at.