Influence of the Timing of Antibiotic Administration and Control of Infectious Foci on the Prognosis of Adult Patients with Critical Surgical Sepsis.

BACKGROUND

Delay in administration of antibiotics and surgical control of the infection source are linked to increased mortality in septic patients.

OBJECTIVE

The primary objective was to assess the impact of delays in administering the first antibiotic dose and the timing of surgical control of the infection source on in-hospital mortality.

METHOD

This single-center, retrospective observational study included 155 critically ill septic patients admitted to hospital emergency department (ED). All patients underwent surgical control of the infection source before admission to the intensive care unit (ICU).

RESULTS

The median time to the first antibiotic dose was 5.6 hours (IQR: 2.5-10.8) and the median time to surgery was 11.3 hours (IQR: 6.7-21.8). Only 28% of patients received antibiotic therapy within the first 3 hours, and 23.2% underwent surgery within the first 6 hours after ED arrival. Mortality rates did not differ significantly between patients who received antibiotics within 3 hours vs. later (25.0% vs. 15.3%, p = 0.158), those with or without septic shock (50.0% vs. 43.3%, p = 0.519), or based on surgical timing (p = 0.085). Older patients exhibited higher mortality (p = 0.036). Multivariate analysis revealed that only patient age, chronic kidney disease (CKD), and a time to surgery of less than 6 hours from hospital arrival were independently associated with mortality. A strong correlation was found between delays in administering the first antibiotic dose and delays in surgery (p < 0.0001).

CONCLUSION

In our series, septic patients requiring control of the infectious focus did not benefit from the combination of early antibiotic administration and faster surgical intervention. Older age was associated with higher mortality. Additionally, delays in antibiotic administration were strongly correlated with delays in surgical intervention, highlighting the need for streamlined sepsis management protocols.