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 2020 Wolters Kluwer Health, Inc.
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 Type:||Refereed Article|
|Keywords:||sepsis, antibiotics, early administration, emergency department, systematic review|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Clinical sciences|
|Objective Group:||Evaluation of health and support services|
|Objective Field:||Evaluation of health outcomes|
|UTAS Author:||Allen, P (Dr Penny Allen)|
|Web of Science® Times Cited:||5|
|Deposited By:||Rural Clinical School|
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