A study of patients with presumed community-onset sepsis found that certain presenting symptoms were associated with timely antibiotics, researchers report today in JAMA Network Open.
For the study, a team of US researchers looked at data on nearly 30,000 adults who presented with community-onset bacterial sepsis at 67 hospitals belonging to the Michigan Hospital Medicine Safety Consortium-Sepsis Initiative.
Prompt initiation of antibiotics (within three hours of hospital presentation if septic shock is absent) is considered critical for patients with sepsis, a leading cause of in-hospital death in the United States, and previous studies have found that certain patient and hospital characteristics are associated with antibiotic timing.
But the study authors note that few studies have examined whether presenting symptoms affect the timing of antibiotic administration.
“This is an important gap, as clinicians rely on presenting symptoms to diagnose infection and make decisions about antibiotic initiation,” they wrote.
Prehospital fever linked to higher odds of timely antibiotics
The cohort included 29,647 patients (median age, 71 years), of whom 21,957 (74%) received timely antibiotics.
Among patients with and without hypotension, multivariable analysis found that prehospital fever was associated increased odds of timely antibiotics (with hypotension: adjusted odds ratio [aOR, 1.34]; without hypotension: aOR, 1.26), while gastrointestinal symptoms were associated with decreased odds of timely antibiotics (with hypotension: aOR, 0.84; without hypotension: aOR, 0.80).
Urinary (aOR, 1.13) and respiratory (aOR, 0.91) symptoms were also associated with antibiotic timing for patients without hypotension. Among the entire study cohort, timely antibiotics were associated with reduced 30-day mortality (18.9% vs 21.0%; adjusted absolute difference, –2.10 percentage points).
“These findings suggest that proactive screening for sepsis among patients with less obvious clinical presentations may promote timely recognition and treatment,” the authors concluded.