A new study published in JAMA Network Open provides evidence that delays in administering antibiotics are linked with a higher risk of mortality in children with sepsis.
Pediatric consensus guidelines have historically recommended “antibiotic administration within 1 hour for septic shock and within 3 hours for sepsis without shock,” and some studies have noted that there is a point at which a delay in antibiotic administration can be associated with worse outcomes. The researchers behind this study set out to “determine a time point for antibiotic administration that is associated with increased risk of mortality among pediatric patients with sepsis.”
The cohort study analyzed data from patients aged 29 days to less than 18 years across 51 U.S. children’s hospitals. All of the patients had “sepsis recognized within 1 hour of emergency department arrival, from January 1, 2017, through December 31, 2021.” Then, the time was tracked between emergency department arrival to antibiotic administration.
In total, the researchers studied 19,515 cases. The median time to antibiotic administration was 69 minutes. Researchers found that “the estimated time to antibiotic administration at which 3-day sepsis-attributable mortality increased was 330 minutes.” Patients who received an antibiotic in less than 330 minutes had a sepsis-attributable 3-day mortality of 0.5% (93 patients) and 30-day mortality of 0.9% (163 patients), whereas patients who received an antibiotic at 330 minutes or later had 3-day sepsis mortality of 1.2% (4 patients) and 30-day mortality of 2.0% (7 patients).
The researchers concluded that prior literature demonstrating “increased pediatric sepsis mortality associated with antibiotic administration delay” was consistent with their results. They also emphasize the need for “further research” into certain subpopulations, like those with shock or bacteremia, to determine if they would benefit from earlier antibiotics.
