Optimal timing of antibiotics administration for sepsis or septic shock in the emergency department
Year: 2026
Type: other
Abstract: Objectives Early antibiotic administration is considered an important component of sepsis management, yet the optimal time-to-antibiotics (T2A) remains uncertain. This study examined the association between T2A and in-hospital mortality among patients with sepsis and septic shock and explored how this relationship varies across different time intervals. Methods We conducted a retrospective cohort analysis of emergency department patients with sepsis from 1998 to 2022. Patients were dichotomized into two groups (T2A ≤ 1 h vs. T2A > 1 h), and clinical characteristics and mortality outcomes were compared. Cox proportional hazards models were used to assess the association between T2A and in-hospital mortality, adjusting for illness severity and other covariates. A non-linear Cox regression model was further applied to characterize the time-dependent relationship between T2A and mortality risk. Results A total of 15,317 patients were included. In-hospital mortality was 35.9% for patients receiving antibiotics within 1 h and 47.4% for those treated after 1 h (P < 0.001). After adjustment, T2A ≤ 1 h remained associated with lower mortality (adjusted HR = 0.936; 95% CI, 0.891–0.982). Non-linear modeling suggested that mortality risk was generally lower when antibiotics were administered within approximately 3 h, with the lowest estimated hazard observed at around 0.5 h; risk increased more noticeably beyond the 3-hour mark. These patterns were consistent across patients with and without septic shock. Conclusion In this large retrospective cohort, shorter time-to-antibiotics was associated with lower in-hospital mortality, with the most favorable estimates occurring within the first hour and a gradual attenuation of benefit approaching 3 h. These findings provide insight into the time-dependent relationship between antibiotic administration and outcomes in sepsis that warrants further validation before being incorporated into clinical practice recommendations. Clinical trial number Not applicable.
Source: Figshare
Institutions: National Yang Ming Chiao Tung University, Taipei Veterans General Hospital, Taichung Veterans General Hospital, National Taiwan University, Hsin Sheng College of Medical Care and Management, China Medical University, China Medical University, National Chung Hsing University, Chung Shan Medical University
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7128399403
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