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Time to initial antibiotic administration, and short-term mortality among patients admitted with community-acquired severe infections with and without the presence of systemic inflammatory response syndrome: a follow-up study
  1. Daniel Pilsgaard Henriksen1,2,
  2. Christian B Laursen3,
  3. Jesper Hallas2,4,
  4. Court Pedersen5,
  5. Annmarie Touborg Lassen1
  1. 1Department of Emergency Medicine, Odense University Hospital, Odense C, Denmark
  2. 2Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
  3. 3Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark
  4. 4Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark
  5. 5Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
  1. Correspondence to Daniel Pilsgaard Henriksen, Department of Emergency Medicine, Odense University Hospital, Denmark, Sdr. Boulevard 29, Entrance 132, 1st floor, Odense C DK-5000, Denmark; dphenriksen{at}health.sdu.dk

Abstract

Background The prognosis for patients with severe infection is related to early treatment, including early administration of antibiotics. The study aim was to compare the short-term mortality among patients admitted with severe infection with and without systemic inflammatory response syndrome (SIRS) at arrival, and to ascertain whether the presence of SIRS might affect the timing of antibiotic administration.

Methods In this retrospective follow-up study, we included all adult patients (≥15 years) presenting to a medical emergency department in the period between September 2010 and August 2011 with a first-time admission of community-acquired severe infection (infection with evidence of organ dysfunction), with and without SIRS at arrival. The presence of SIRS was defined as two or more of the criteria according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) definitions. Cases were identified by manual chart review using predefined criteria of infection. Data on vital signs, laboratory values and antibiotic treatment were obtained electronically.

Results We included 1169 patients with infection and organ dysfunction, treated with antibiotics within 24 h after arrival (median age 76.1 years (IQR 63.1–83.5), 567 (48.5%) men). In all, 886 (75.8%) presented with SIRS, and 283 (24.2%) presented without SIRS. Median time to antibiotics was 4.6 h (IQR 2.9–7.0) in patients with SIRS and 6.7 h (IQR 4.5–10.3) in patients without SIRS (p<0.0001). Thirty-day mortality in patients with and without SIRS was 18.4% (95% CI 15.9% to 21.1%) and 16.6% (95% CI 12.5% to 21.5%), respectively.

Conclusions SIRS was absent in one-quarter of patients admitted with severe infection. The ‘door-to-antibiotics’ time was significantly shorter for patients with SIRS compared with patients without SIRS, but no difference was found in 30-day mortality.

  • infectious diseases
  • emergency department
  • epidemiology

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