Scholarlink

Objectives <p>Early antibiotic administration is considered an important component of sepsis management, yet the optimal time-to-antibiotics (T2A) remains uncertain. This study examined the association between T2A and in-hospital mortality among patients with sepsis and septic shock and explored how this relationship varies across different time intervals.</p> Methods <p>We conducted a retrospective cohort analysis of emergency department patients with sepsis from 1998 to 2022. Patients were dichotomized into two groups (T2A ≤ 1&#xa0;h vs. T2A &gt; 1&#xa0;h), and clinical characteristics and mortality outcomes were compared. Cox proportional hazards models were used to assess the association between T2A and in-hospital mortality, adjusting for illness severity and other covariates. A non-linear Cox regression model was further applied to characterize the time-dependent relationship between T2A and mortality risk.</p> Results <p>A total of 15,317 patients were included. In-hospital mortality was 35.9% for patients receiving antibiotics within 1&#xa0;h and 47.4% for those treated after 1&#xa0;h (<i>P</i> &lt; 0.001). After adjustment, T2A ≤ 1&#xa0;h remained associated with lower mortality (adjusted HR = 0.936; 95% CI, 0.891–0.982). Non-linear modeling suggested that mortality risk was generally lower when antibiotics were administered within approximately 3&#xa0;h, with the lowest estimated hazard observed at around 0.5&#xa0;h; risk increased more noticeably beyond the 3-hour mark. These patterns were consistent across patients with and without septic shock.</p> Conclusion <p>In this large retrospective cohort, shorter time-to-antibiotics was <i>associated</i> with lower in-hospital mortality, with the most favorable estimates occurring within the first hour and a gradual attenuation of benefit approaching 3&#xa0;h. These findings provide insight into the time-dependent relationship between antibiotic administration and outcomes in sepsis that warrants further validation before being incorporated into clinical practice recommendations.</p> Clinical trial number <p>Not applicable.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Optimal timing of antibiotics administration for sepsis or septic shock in the emergency department

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月19日

查看全文
  • Ming-Shun Hsieh,
  • Kuan-Chih Chiu,
  • Shu-Hui Liao,
  • Vivian Chia-Rong Hsieh,
  • Sung-Yuan Hu,
  • Chorng-Kuang How

摘要

Objectives

Early antibiotic administration is considered an important component of sepsis management, yet the optimal time-to-antibiotics (T2A) remains uncertain. This study examined the association between T2A and in-hospital mortality among patients with sepsis and septic shock and explored how this relationship varies across different time intervals.

Methods

We conducted a retrospective cohort analysis of emergency department patients with sepsis from 1998 to 2022. Patients were dichotomized into two groups (T2A ≤ 1 h vs. T2A > 1 h), and clinical characteristics and mortality outcomes were compared. Cox proportional hazards models were used to assess the association between T2A and in-hospital mortality, adjusting for illness severity and other covariates. A non-linear Cox regression model was further applied to characterize the time-dependent relationship between T2A and mortality risk.

Results

A total of 15,317 patients were included. In-hospital mortality was 35.9% for patients receiving antibiotics within 1 h and 47.4% for those treated after 1 h (P < 0.001). After adjustment, T2A ≤ 1 h remained associated with lower mortality (adjusted HR = 0.936; 95% CI, 0.891–0.982). Non-linear modeling suggested that mortality risk was generally lower when antibiotics were administered within approximately 3 h, with the lowest estimated hazard observed at around 0.5 h; risk increased more noticeably beyond the 3-hour mark. These patterns were consistent across patients with and without septic shock.

Conclusion

In this large retrospective cohort, shorter time-to-antibiotics was associated with lower in-hospital mortality, with the most favorable estimates occurring within the first hour and a gradual attenuation of benefit approaching 3 h. These findings provide insight into the time-dependent relationship between antibiotic administration and outcomes in sepsis that warrants further validation before being incorporated into clinical practice recommendations.

Clinical trial number

Not applicable.