ADMINISTERING antibiotics more than 1 hour after emergency department presentation for suspected sepsis significantly increases the risk of 28-day in-hospital mortality, according to a new multicentre analysis from the 1-Bundle Emergency Department Trial.
The post hoc analysis included 872 adult patients with suspected sepsis, enrolled across 23 emergency departments in France and Spain between June 2022 and September 2023. The study assessed the association between time to antibiotic administration and clinical outcomes, including mortality. A subgroup analysis examined patients without hypotension to evaluate whether the association held in less severe cases. Data on fluid resuscitation timing were also reviewed, although this was not the primary focus.
Among the 859 patients with complete antibiotic data, the median time to administration was 61 minutes. Of these, 791 patients (92%) received antibiotics, with 58% receiving them within the first hour. In-hospital mortality at 28 days was 14.7% for patients who received antibiotics after 1 hour compared to 9.6% for those treated within 1 hour. This translated to an adjusted odds ratio (aOR) of 2.00 (95% CI: 1.24–3.23), indicating a two-fold increase in mortality with delayed treatment. Furthermore, each additional hour of delay was associated with a 6% increase in mortality risk (aOR: 1.06, 95% CI: 1.02–1.10).
Importantly, the detrimental effect of delay was also observed in the subgroup without hypotension, with an aOR of 2.02 (95% CI: 1.08–3.76) for those treated after 1 hour. In contrast, timing of fluid resuscitation showed no significant association with mortality.
These findings reinforce the critical importance of prompt antibiotic administration for patients with suspected sepsis, even in the absence of haemodynamic instability.
Reference
Philippon AL et al. Association between time to antibiotic and mortality in patients with suspected sepsis in the Emergency Department: post hoc analysis of the 1-BED randomized clinical trial. Eur J Emerg Med. 2025;32(2):109-115
