Prompt antimicrobial therapy and source control on survival and defervescence of adults with bacteraemia in the emergency department: the faster, the better
Authors' conclusion
Regardless of the need for source control in cases of bacteraemia, there seems to be a significant association between the prompt administration of appropriate antimicrobials and both a favourable prognosis and rapid defervescence, particularly among critically ill patients.
Study context
- Population
- Treatment-naïve adults with bacteraemia in the ED
- Participants
- 5,477 adults
- Exposure
- Per-hour delay in time-to-appropriate antibiotic (TtAa) or time-to-source control (TtSc)
- ScUn = 3,953
- Source-control-required (ScR)n = 1,524
- Outcome
- 30-day crude mortality
- Follow-up
- 30 days
Methodological detailsretrospective clinical data, prospectively restored pathogens, logistic regression adjustment
- Retrospective clinical data
- Prospectively restored pathogens
- Logistic regression adjustment
Main finding
As reported in the abstract
Adjusted odds ratio
1.002
P < 0.001
ScU · average 0.2% increase in mortality per hour
Adjusted odds ratio
1.003
P < 0.001
ScR · average 0.3% increase in mortality per hour
Observational data: associations, not effects.
Further findings
Mortality per hour of TtAa delay, critically ill (subgroup)
- ScU: average increase per hour
- 0.4%
- ScR: average increase per hour
- 0.5%
Mortality per hour of TtSc delay, ScR
- Overall: average increase per hour
- 0.31%
- Critically ill: average increase per hour
- 0.33%
- Significant
Delayed defervescence per hour of TtAa delay, febrile patients
- ScU (3085 patients): average increase per hour
- 0.2%
- ScR (1266): average increase per hour
- 0.3%
- ScU, critically ill: average increase per hour
- 0.5%
- ScR, critically ill: average increase per hour
- 0.9%
- Significant
Mortality per hour of TtSc delay, febrile ScR (n 1266)
- Overall: average increase per hour
- 0.3%
- Critically ill: average increase per hour
- 0.4%
- Significant
Original publication
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