Time to antimicrobial therapy in septic shock patients treated with an early goal-directed resuscitation protocol

dc.contributor.authorBulle, Esther B.en
dc.contributor.authorPeake, Sandra L.en
dc.contributor.authorFinnis, Marken
dc.contributor.authorBellomo, Rinaldoen
dc.contributor.authorDelaney, Anthonyen
dc.contributor.authorPeake, C.en
dc.contributor.authorCameron, P. A.en
dc.contributor.authorHiggins, A. M.en
dc.contributor.authorHoldgate, A.en
dc.contributor.authorHowe, B. D.en
dc.contributor.authorWebb, S. A.R.en
dc.contributor.authorWilliams, P.en
dc.contributor.authorCooper, D. J.en
dc.contributor.authorCross, A.en
dc.contributor.authorGomersall, C.en
dc.contributor.authorGraham, C.en
dc.contributor.authorHoldgate, A.en
dc.contributor.authorHowe, B. D.en
dc.contributor.authorJacobs, I.en
dc.contributor.authorJohanson, S.en
dc.contributor.authorJones, P.en
dc.contributor.authorKruger, P.en
dc.contributor.authorMcArthur, C.en
dc.contributor.authorMyburgh, J.en
dc.contributor.authorNichol, A.en
dc.contributor.authorPettilä, V.en
dc.contributor.authorRajbhandari, D.en
dc.contributor.authorWilliams, A.en
dc.contributor.authorWilliams, J.en
dc.contributor.authorWilliams, P.en
dc.contributor.authorBennett, V.en
dc.contributor.authorBoard, J.en
dc.contributor.authorMcCracken, P.en
dc.contributor.authorMcGloughlin, S.en
dc.contributor.authorNanjayya, V.en
dc.contributor.authorTeo, A.en
dc.contributor.authorHill, E.en
dc.contributor.authorJones, P.en
dc.contributor.authorO'Brien, E.en
dc.contributor.authorSawtell, F.en
dc.contributor.authorSchimanski, K.en
dc.contributor.authorWilson, D.en
dc.contributor.authorBolch, S.en
dc.contributor.authorEastwood, G.en
dc.contributor.authorKerr, F.en
dc.contributor.authorPeak, L.en
dc.contributor.authorYoung, H.en
dc.contributor.authorEdington, J.en
dc.contributor.authorMitchell, I.en
dc.contributor.authorRodgers, H.en
dc.date.accessioned2025-07-08T12:09:04Z
dc.date.available2025-07-08T12:09:04Z
dc.date.issued2020-10-09en
dc.description.abstractObjective: Intravenous antimicrobial therapy within 1 h of the diagnosis of septic shock is recommended in international sepsis guidelines. We aimed to evaluate the association between antimicrobial timing and mortality in patients presenting to the ED with septic shock. Methods: Post-hoc analysis of 1587 adult participants enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) multicentre trial of early goal-directed therapy for whom the time of initial antimicrobial therapy was recorded. We compared participants who had initiation of antimicrobials within the first hour (early) or later (delayed) of ED presentation. A propensity score model using inverse probability of treatment weighting was constructed to account for confounding baseline covariates. The primary outcome was 90-day mortality. Results: The median (interquartile range) time to initiating antimicrobials was 69 (39–112) min with 712 (44.9%) participants receiving the first dose within the first hour of ED presentation. Compared with delayed therapy, early administration was associated with increased baseline illness severity score and greater intensity of resuscitation pre-randomisation (fluid volumes, vasopressors, invasive ventilation). All-cause 90-day mortality was also higher; 22.6% versus 15.5%; unadjusted odds ratio (OR) 1.58 (95% confidence interval [CI] 1.16–2.15), P = 0.004. After inverse probability of treatment weighting, the mortality difference was non-significant; OR 1.30 (95% CI 0.95–1.76), P = 0.1. Live discharge rates from ICU (OR 0.81, 95% CI 0.72–0.91; P = 0.80) and hospital (OR 0.93, 95% CI 0.82–1.06; P = 0.29) were also not different between groups. Conclusion: In this post-hoc analysis of the ARISE trial, early antimicrobial therapy was associated with increased illness severity, but 90-day adjusted mortality was not reduced.en
dc.description.sponsorshipThe ARISE trial was endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group and Australasian College for Emergency Medicine. Thank you to Alexander Vlaar for his review of the final manuscript. SLP, EBB designed the study. MF, EBB analysed the data. SLP prepared the original draft and all authors reviewed and contributed to the final version prior to submission. None declared.en
dc.description.statusPeer-revieweden
dc.format.extent9en
dc.identifier.issn1742-6731en
dc.identifier.otherScopus:85092373004en
dc.identifier.otherPubMed:38019012en
dc.identifier.otherORCID:/0000-0001-6013-4922/work/164283359en
dc.identifier.urihttps://hdl.handle.net/1885/733766476
dc.language.isoenen
dc.rightsPublisher Copyright: © 2020 Australasian College for Emergency Medicineen
dc.sourceEMA - Emergency Medicine Australasiaen
dc.subjectmortalityen
dc.subjectseptic shocken
dc.subjecttiming anti-microbial agenten
dc.titleTime to antimicrobial therapy in septic shock patients treated with an early goal-directed resuscitation protocolen
dc.typeJournal articleen
dspace.entity.typePublicationen
local.bibliographicCitation.lastpage417en
local.bibliographicCitation.startpage409en
local.contributor.affiliationBulle, Esther B.; Amsterdam University Medical Centreen
local.contributor.affiliationPeake, Sandra L.; Queen Elizabeth Hospital Australiaen
local.contributor.affiliationFinnis, Mark; University of Adelaideen
local.contributor.affiliationBellomo, Rinaldo; Monash Universityen
local.contributor.affiliationDelaney, Anthony; Monash Universityen
local.contributor.affiliationMitchell, I.; Canberra Clinical School, School of Medicine and Psychology, ANU College of Science and Medicine, The Australian National Universityen
local.contributor.affiliationRodgers, H.; National Centre for Epidemiology and Population Health, Centre of Epidemiology for Policy and Practice, National Centre for Epidemiology and Population Health, ANU College of Law, Governance and Policy, The Australian National Universityen
local.identifier.citationvolume33en
local.identifier.doi10.1111/1742-6723.13634en
local.identifier.purec16bc9ce-bd9b-4943-a71b-c9bb6bb67048en
local.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85092373004&partnerID=8YFLogxKen
local.type.statusPublisheden

Downloads