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.

Objections from the United States and European Union (EU) prevented United Nations (UN) member states from adopting a pact to help improve the world’s response to the next pandemic. 

At its second High-Level Meeting on pandemic prevention, preparedness and response (PPPR), member states met with the hopes of endorsing a declaration that would officially recognize the World Health Organization Pandemic Agreement, a plan that establishes the principles, strategies, and tools for better international coordination on PPPR. The agreement has been in the works since 2021 and was adopted by the World Health Assembly in May 2025.

The declaration also calls for finalizing an annex to the agreement, the Pathogen Access and Benefit-Sharing System, which establishes a system for the timely sharing of pathogens with pandemic potential, enabling rapid development of diagnostics, treatments, and vaccines.

“The Pathogen Access and Benefit Sharing System, under negotiation, is critical to unlocking the full potential of the WHO Pandemic Agreement. There is no time to waste,” UN Deputy Secretary-General Amina Mohammed said in a WHO news release.

US, EU objections

But US Centers for Disease Control and Prevention Director Erica Schwartz, MD, MPH, JD, said at the meeting that critical issues remain unresolved.

“Whether it is the inclusion of divisive ideologies that lack definitional consensus or references to an unfinished negotiation on pathogen access and benefit sharing in an agreement that failed to achieve international consensus, the United States is not in a position to support this text,” Schwartz said, according to Health Policy Watch.  

A statement from the EU representative said that while the declaration offers elements that will advance PPPR, it “also contains setbacks toward our crucial, shared goal: a safer, healthier world for all.”

Among the “red lines” noted in the statement was technology transfer, which it said must be voluntary and on mutually agreed terms.

“While the text before us today falls short of our expectations and goals, the EU remains fully and unreservedly committed to the important overarching objective of the Political Declaration,” the EU said.

The declaration is expected to be taken up at a future UN General Assembly meeting.