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'Every Hour Matters': Delaying Sepsis Antibiotics in ER Increases Odds of Mortality

By Christopher Cheney  
   June 07, 2019

New research finds that every hour of delay in administering antibiotics to sepsis patients in emergency rooms increases odds of 1-year mortality.

In the emergency department setting, timely administration of antibiotics to patients with clinical sepsis saves lives, recent research indicates.

Sepsis is a common and life-threatening reaction to infection that affects at least 850,000 adult patients treated in EDs annually. Sepsis kills nearly 270,000 Americans each year, and 1-in-3 of patients who die in hospitals have sepsis, according to the Centers for Disease Control and Prevention.

The recent research published in CHEST associated each additional hour from emergency room arrival to antibiotic administration to 10% increased odds of 1-year mortality.

The lead author of the study told HealthLeaders that speedy recognition and treatment of sepsis is crucial in the ED.

"Our research adds to the evidence that every hour matters when it comes to initiation of appropriate antibiotics for sepsis, impacting not just short-term but also long-term mortality. The fact that the association was fairly linear suggests there is no acceptable window of delay," said Ithan Peltan, MD, MSc, an attending physician in the Department of Medicine at Intermountain Medical Center in Murray, Utah.

The research features data collected from nearly 11,000 patients, who experienced a 19% 1-year mortality rate.

'This data is convincing'

The evidence is strong that early administration of antibiotics for sepsis patients in the ED is beneficial, Peltan said.

"The association of antibiotic timing and mortality observed here is logical, supported by pre-clinical data, and consistent in direction and magnitude with other large, well-designed studies of using different outcomes and different criteria to identify sepsis patients. Overall, at this point, this data is convincing," he said.

Peltan cautioned that emergency medicine clinicians need to keep antibiotics stewardship in mind when treating suspected cases of sepsis.

"Our data support efforts to initiate appropriate antibiotics as soon as possible for patients with sepsis to reduce both short-term and long-term mortality. Efforts to speed antibiotic delivery, however, must be designed so as not to encourage the indiscriminate treatment we sometimes saw associated with pneumonia care."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Sepsis is a common and life-threatening condition that kills nearly 270,000 Americans annually.

New sepsis research found that each additional hour from emergency room arrival to antibiotic administration increased odds of 1-year mortality by 10%.

Evidence is mounting that early initiation of antibiotics for sepsis patients in the ER is beneficial.

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