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Antibiotics administered within 1 hour to adult emergency department patients screened positive for sepsis: a systematic review

Citation

Xantus, G and Allen, P and Norman, S and Kanizsai, P, Antibiotics administered within 1 hour to adult emergency department patients screened positive for sepsis: a systematic review, European Journal of Emergency Medicine, 27, (4) pp. 260-267. ISSN 0969-9546 (2020) [Refereed Article]

Copyright Statement

Copyright 2020 Wolters Kluwer Health, Inc.

DOI: doi:10.1097/MEJ.0000000000000654

Abstract

Objective: The 2018 Surviving Sepsis Campaign update recommended instigating the Sepsis-6 bundle within 1 h; however, the supporting evidence is weak. The objective was to systematically review the literature to determine whether there is mortality benefit (hospital or 28/30-day survival) associated with administration of antibiotics <1 h to adult emergency department (ED) patients screened positive for sepsis using systemic inflammatory response system criteria.

Methods: A systematic review and meta-analysis were conducted. Embase, CINAHL, Medline, Pubmed, Cochrane Library and grey literature were searched for articles published between 2012 and 2019.

Results: From 232 identified articles, seven met the inclusion criteria. Due to the small number of articles that fit the inclusion criteria and the considerable heterogeneity (I = 92.6%, P < 0.001), only the results of the systematic review are reported. Three of the seven studies demonstrated survival benefit for patients who screened positive for sepsis who were administered antibiotics ≤1 h after presentation to the ED. Four studies reported no statistically significant improvement in survival associated with administration of antibiotics within 1 h of ED presentation. Interestingly, two studies reported worse outcomes associated with early administration of antibiotics in patients with low acuity sepsis.

Conclusion: There is equivocal evidence of in-hospital or 28/30-day survival benefit associated with antibiotics administered ≤1 h after presentation to the ED for patients who screened positive for sepsis. Further research is needed to identify the exact patient group, which would truly benefit from initiation of antibiotics <1 h after ED presentation.

Item Details

Item Type:Refereed Article
Keywords:sepsis, antibiotics, early administration, emergency department, systematic review
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Paramedicine
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Allen, P (Dr Penny Allen)
ID Code:140953
Year Published:2020
Web of Science® Times Cited:7
Deposited By:Rural Clinical School
Deposited On:2020-09-16
Last Modified:2021-04-21
Downloads:0

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