Door-to-antibiotic Time and In-hospital Mortality of Elder Patients Presenting to Emergency Department with Sepsis; a Cross-Sectional Study
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
,
Page e44
https://doi.org/10.22037/aaem.v9i1.1266
Abstract
Introduction: The current international sepsis guideline recommends that administration of intravenous broad-spectrum antibiotics should be initiated within 1 hour of emergency department (ED) arrival for sepsis patients. This study aimed to evaluate the association between door-to-antibiotic time and in-hospital mortality of these patients.
Methods: In this retrospective cross-sectional study, elderly patients (age ≥65 years) diagnosed with sepsis in the ED of a tertiary referral and academic hospital from January to December 2019 were enrolled. Door-to-antibiotic time was defined as the time from ED arrival to antibiotic initiation. The associations of door-to-antibiotic time and each hour delay in first antibiotic initiation with in-hospital mortality were assessed.
Results: Six hundred patients with the median age of 78.0 (IQR: 72.0-86.0) were studied (50.8% female). The median door-to-antibiotic time was 51.0 (36.0 – 89.0) minutes and in-hospital mortality rate was 12.5%. There was no significant difference in the in-hospital mortality rate between door-to-antibiotic time ≤1 hour and >1 hour (13.1% vs. 11.6%, p = 0.726). When considering hour-upon-hour of door-to-antibiotic time, no significant difference in in-hospital mortality was observed (p = 0.866). Factors that led to a delay in door-to-antibiotic time were presenting body temperature <38°C (odds ratio [OR] 3.34; 95% CI, 2.12-5.29; p < 0.001) and age <75 years (OR 1.7; 95% CI, 1.09-2.64; p = 0.019).
Conclusion: Door-to-antibiotic time was not associated with in-hospital mortality in elderly sepsis patients in this study. Significant factors that led to a delay in door-to-antibiotic time were no fever, age <75 years, doctor time, and blood sample taking time.
- mortality
- Anti-Bacterial Agents
- Emergency Service
- Hospital
- Quality of Health Care
- Sepsis
- Aged
- Aged, 80 and over
How to Cite
References
Prescott HC, Angus DC. Enhancing recovery from sepsis: a review. Jama. 2018;319(1):62-75.
Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. American journal of respiratory and critical care medicine. 2016;193(3):259-72.
Wang HE, Jones AR, Donnelly JP. Revised national estimates of emergency department visits for sepsis in the United States. Critical care medicine. 2017;45(9):1443.
Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. Jama. 2014;311(13):1308-16.
Rutschmann OT, Chevalley T, Zumwald C, Luthy C, Vermeulen B, Sarasin F. Pitfalls in the emergency department triage of frail elderly patients without specific complaints. Swiss medical weekly. 2005;135(9-10):145-50.
Chou M-Y, Chou S-L, Tzeng Y-M, Chen L-K, Yen DH-T, Hwang S-J, et al. Emergency department (ED) utilization and outcome of oldest old men presenting with geriatric syndromes in a veterans care home in Taiwan. Archives of gerontology and geriatrics. 2009;49:S32-S6.
Girard TD, Ely EW. Bacteremia and sepsis in older adults. Clinics in geriatric medicine. 2007;23(3):633-47.
Emmett K. Nonspecific and atypical presentation of disease in the older patient. Geriatrics (Basel, Switzerland). 1998;53(2):50-2, 8.
Limpawattana P, Phungoen P, Mitsungnern T, Laosuangkoon W, Tansangworn N. Atypical presentations of older adults at the emergency department and associated factors. Archives of gerontology and geriatrics. 2016;62:97-102.
Henning DJ, Carey JR, Oedorf K, Day DE, Redfield CS, Huguenel CJ, et al. The absence of fever is associated with higher mortality and decreased antibiotic and IV fluid administration in emergency department patients with suspected septic shock. Critical care medicine. 2017;45(6):e575-e82.
Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Critical care medicine. 2014;42(8):1749-55.
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical care medicine. 2006;34(6):1589-96.
Liu VX, Fielding-Singh V, Greene JD, Baker JM, Iwashyna TJ, Bhattacharya J, et al. The timing of early antibiotics and hospital mortality in sepsis. American journal of respiratory and critical care medicine. 2017;196(7):856-63.
Seymour CW, Kahn JM, Martin-Gill C, Callaway CW, Yealy DM, Scales D, et al. Delays from first medical contact to antibiotic administration for sepsis. Critical care medicine. 2017;45(5):759.
Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to treatment and mortality during mandated emergency care for sepsis. New England Journal of Medicine. 2017;376(23):2235-44.
Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive care medicine. 2018;44(6):925-8.
Force IST. Infectious Diseases Society of America (IDSA) position statement: why IDSA did not endorse the surviving sepsis campaign guidelines. Clinical Infectious Diseases. 2018;66(10):1631-5.
Sterling SA, Miller WR, Pryor J, Puskarich MA, Jones AE. The impact of timing of antibiotics on outcomes in severe sepsis and septic shock: a systematic review and meta-analysis. Critical care medicine. 2015;43(9):1907.
Bloos F, Thomas-Rüddel D, Rüddel H, Engel C, Schwarzkopf D, Marshall JC, et al. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Critical care. 2014;18(2):1-10.
Puskarich MA, Trzeciak S, Shapiro NI, Arnold RC, Horton JM, Studnek JR, et al. Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Critical care medicine. 2011;39(9):2066.
Tongnoon P, Srisook N. A retrospective study for the association between the length of stay in an emergency room and the mortality rate among adult sepsis patients in the emergency department of a tertiary care hospital in the south of Thailand [Dissertation]: Songkhla: Prince of Songkla University; 2020.
Peltan ID, Brown SM, Bledsoe JR, Sorensen J, Samore MH, Allen TL, et al. ED door-to-antibiotic time and long-term mortality in sepsis. Chest. 2019;155(5):938-46.
Abe T, Kushimoto S, Tokuda Y, Phillips GS, Rhodes A, Sugiyama T, et al. Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: a descriptive analysis of a prospective observational study. Critical Care. 2019;23(1):1-11.
Ko BS, Choi S-H, Shin TG, Kim K, Jo YH, Ryoo SM, et al. Impact of 1-Hour Bundle Achievement in Septic Shock. Journal of clinical medicine. 2021;10(3):527.
Worapratya P, Joraluck J, Wanjaroenchaisuk A, Wuthisuthimethawee P. Appropriateness of Broad Spectrum Antibiotics for Severe Sepsis and Septic Shock in the Emergency Department. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet. 2016;99(5):477-83.
Martin-Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, Irazabal M, et al. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study. Annals of intensive care. 2019;9(1):1-9.
Vardi M, Ghanem-Zoubi N, Bitterman H, Abo-Helo N, Yurin V, Weber G, et al. Sepsis in nonagenarians admitted to internal medicine departments: a comparative study of outcomes. QJM: An International Journal of Medicine. 2013;106(3):261-6.
Rumbus Z, Matics R, Hegyi P, Zsiboras C, Szabo I, Illes A, et al. Fever is associated with reduced, hypothermia with increased mortality in septic patients: a meta-analysis of clinical trials. PLoS One. 2017;12(1):e0170152.
Ittisanyakorn M, Ruchichanantakul S, Vanichkulbodee A, Sri-On J. Prevalence and factors associated with one-year mortality of infectious diseases among elderly emergency department patients in a middle-income country. BMC infectious diseases. 2019;19(1):1-10.
Limpawattana P. A secondary analysis of atypical presentations of older patients with infection in the emergency department of a tertiary care hospital in Thailand. Asian Biomed. 2016:181.
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