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Delay of appropriate antibiotic treatment is associated with high mortality in patients with community-onset sepsis in a Swedish setting
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
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2019 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 38, no 7, p. 1223-1234Article in journal (Refereed) Published
Abstract [en]

Early appropriate antimicrobial therapy is crucial in patients with sepsis and septic shock. Studies often focus on time to first dose of appropriate antibiotics, but subsequent dosing is equally important. Our aim was to investigate the impact of fulfillment of early treatment, with focus on appropriate administration of first and second doses of antibiotics, on 28-day mortality in patients with community-onset severe sepsis and septic shock. A retrospective study on adult patients admitted to the emergency department with community-onset sepsis and septic shock was conducted 2012-2013. The criterion early appropriate antibiotic treatment was defined as administration of the first dose of adequate antibiotics within 1h, and the second dose given with less than 25% delay after the recommended dose interval. A high-risk patient was defined as a septic patient with either shock within 24h after arrival or red triage level on admittance according to the Medical Emergency Triage and Treatment System Adult. Primary endpoint was 28-day mortality. Of 90 patients, less than one in four (20/87) received early appropriate antibiotic treatment, and only one in three (15/44) of the high-risk patients. The univariate analysis showed a more than threefold higher mortality among high-risk patients not receiving early appropriate antibiotic treatment. Multivariable analysis identified early non-appropriate antibiotic treatment as an independent predictor of mortality with an odds ratio for mortality of 10.4. Despite that the importance of early antibiotic treatment has been established for decades, adherence to this principle was very poor.

Place, publisher, year, edition, pages
SPRINGER , 2019. Vol. 38, no 7, p. 1223-1234
Keywords [en]
Sepsis; Septic shock; Antibiotics; Mortality; Emergency department
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-158846DOI: 10.1007/s10096-019-03529-8ISI: 000471726700003PubMedID: 30911928OAI: oai:DiVA.org:liu-158846DiVA, id: diva2:1337650
Note

Funding Agencies|County of Ostergotland [2013/466-31]

Available from: 2019-07-16 Created: 2019-07-16 Last updated: 2019-11-07

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Andersson, MariaÖstholm Balkhed, ÅseFredrikson, MatsHolmbom, MartinHällgren, AnitaBerg, SörenHanberger, Håkan
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Division of Microbiology, Infection and InflammationFaculty of Medicine and Health SciencesDepartment of Infectious DiseasesDivision of Neuro and Inflammation ScienceDepartment of Urology in ÖstergötlandDivision of Cardiovascular MedicineDepartment of Thoracic and Vascular Surgery
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