TOPLINE:
In pediatric patients with sepsis presenting to the emergency department (ED), administering antibiotics 330 minutes or later increases the risk for mortality by over three times.
METHODOLOGY:
- The study used a retrospective cohort design and analyzed data from 19,515 pediatric patients presenting with sepsis at 51 children's hospitals in the United States from 2017 to 2021.
- Pediatric patients (age, 29 days to 18 years) were included, with the condition that sepsis was recognized within an hour of ED arrival.
- The primary exposure was the time from ED arrival to antibiotic administration.
- The main outcome was sepsis-attributable 3-day mortality, and the secondary outcome was sepsis-attributable 30-day mortality.
- The median time to antibiotic administration across the study cohort was 69 minutes.
- The 3-day mortality rate attributed to sepsis was significantly higher in patients who received antibiotics 330 minutes or more after ED arrival (1.2%) than in those who were treated within 330 minutes (0.5%).
- Similarly, the 30-day mortality rates were elevated at 2.0% in the group that received delayed treatment compared with 0.9% in the group that was treated within the recommended timeframe.
- Patients who received antibiotics at 330 minutes or later were at a threefold higher risk for 3-day mortality (odds ratio [OR], 3.44; P =.02) and 30-day mortality (OR, 3.63; P =.002).
IN PRACTICE:
The authors wrote, "Long delays in antibiotic therapy are associated with harm in pediatric sepsis." They further added, "Future investigation should involve prospectively identifying patients with bacterial blood infections and studying the effect of antibiotic administration time on outcomes."
SOURCE:
The study was led byRoni D. Lane, MD, from the Division of Pediatric Emergency Medicine, Department of Pediatrics, Primary Children's Hospital, The University of Utah, Salt Lake City, Utah, and published online in JAMA Network Open.
LIMITATIONS:
The small subgroup benefiting from early antibiotic administration for bacteremia limited detailed analysis. Moreover, the exclusion of patients with a time zero over 1 hour from ED arrival may have affected generalizability to patients with late-onset or hospital-onset sepsis. Notably, the lack of severity scores and reliance on proxies such as high-risk conditions and dichotomized lactate levels may have hindered the assessment of the impact of illness severity on outcomes.
DISCLOSURES:
This study was supported by the Children's Hospital Association's Improving Pediatric Sepsis Outcomes collaborative. The authors disclosed funding sources, including grants from the Agency for Healthcare Research and Quality, the National Institutes of Health, the National Institute of Child Health and Human Development, or the National Institute of Neurological Disorders and Stroke, along with personal fees, lodging for sepsis conferences, or stock from pharmaceutical companies.