Delay in antimicrobial treatment can hurt patients with suspected infection

Putting off the administration of antimicrobial therapy in patients with suspected infection is risky and may lead to progression to septic shock, a study has found.

The study included 74,114 adult patients who received their first antimicrobial treatment within 24 hours of triage. None of them had shock on presentation.

Progression to septic shock occurred in 5,510 (7.4 percent) patients. Most of them (88 percent) were given antimicrobials within the first 5 hours from triage.

Multivariate logistic regression model revealed that time to initial antimicrobial administration influenced outcomes such as progression to septic shock (odds ratio [OR], 1.03, 95 percent confidence interval [CI], 1.02–1.04; p<0.001) and in-hospital mortality (OR, 1.02, 95 percent CI, 0.99–1.04; p=0.121).

When controlled for severity of illness, each hour of delay until first antimicrobial administration contributed to a 4-percent increase in the risk of progression to septic shock for every hour up to 24 hours from triage.

Antibiotics were given at an earlier time point in patients with positive quick sequential organ failure assessment (qSOFA) than in those who were positive for Systemic Inflammatory Response Syndrome (SIRS; 0.82 vs 1.2 hours; p<0.05).

However, qSOFA-positive patients at triage had significantly shorter median time to septic shock compared with SIRS-positive patients (11.2 vs 26 hours; p<0.05).

The findings indicate that qSOFA predicts septic shock with greater specificity than SIRS, although the former is associated with a poorer outcome even if the patients receive early antibiotics.