Timely administration of antibiotics is one of the most important interventions in reducing mortality in sepsis. However, administering antibiotics within a strict time threshold in all patients suspected with sepsis will require huge amount of effort and resources and may increase the risk of unintentional exposure to broad-spectrum antibiotics in patients without infection with its consequences. Thus, controversy still exists on whether clinicians should target different time-to-antibiotics thresholds for patients with sepsis versus septic shock. This study analyzed prospectively collected data from an ongoing multicenter cohort of patients with sepsis identified in the emergency department. Adjusted odds ratios (ORs) were compared for in-hospital mortality of patients who had received antibiotics within 1 h to that of those who did not. Spline regression models were used to assess the association of time-to-antibiotics as continuous variables and increasing risk of in-hospital mortality. The differences in the association between time-to-antibiotics and in-hospital mortality were assessed according to the presence of septic shock. Overall, 3035 patients were included in the analysis. Among them, 601 (19.8%) presented with septic shock, and 774 (25.5%) died. The adjusted OR for in-hospital mortality of patients whose time-to-antibiotics was within 1 h was 0.78 (95% confidence interval [CI] 0.61–0.99; p = 0.046). The adjusted OR for in-hospital mortality was 0.66 (95% CI 0.44–0.99; p = 0.049) and statistically significant in patients with septic shock, whereas it was 0.85 (95% CI 0.64–1.15; p = 0.300) in patients with sepsis but without shock. Among patients who received antibiotics within 3 h, those with septic shock showed 35% (p = 0.042) increased risk of mortality for every 1-h delay in antibiotics, but no such trend was observed in patients without shock. Timely administration of antibiotics improved outcomes in patients with septic shock; however, the association between early antibiotic administration and outcome was not as clear in patients with sepsis without shock.

中文翻译：

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脓毒症和脓毒性休克患者的抗生素使用时间和临床结果：一项前瞻性全国多中心队列研究

及时给予抗生素是降低脓毒症死亡率的最重要干预措施之一。然而，对所有疑似脓毒症的患者在严格的时间阈值内使用抗生素将需要大量的努力和资源，并且可能会增加未感染患者无意接触广谱抗生素的风险及其后果。因此，对于临床医生是否应该针对脓毒症和感染性休克患者使用不同的抗生素使用时间阈值，仍然存在争议。本研究分析了从急诊科发现的正在进行的多中心脓毒症患者队列中前瞻性收集的数据。比较了在 1 小时内接受过抗生素治疗的患者与未接受过抗生素治疗的患者的住院死亡率的调整优势比 (ORs)。样条回归模型用于评估使用抗生素的时间作为连续变量与住院死亡率风险增加之间的关联。根据感染性休克的存在评估了使用抗生素的时间与住院死亡率之间的关联差异。总体而言，3035 名患者被纳入分析。其中感染性休克601人（19.8%），死亡774人（25.5%）。使用抗生素的时间在 1 小时内的患者住院死亡率的校正 OR 为 0.78（95% 置信区间 [CI] 0.61-0.99；p = 0.046）。院内死亡率的校正 OR 为 0.66（95% CI 0.44–0.99；p = 0.049），在感染性休克患者中具有统计学意义，而在感染性休克患者中为 0.85（95% CI 0.64–1.15；p = 0.300）。败血症但无休克。在 3 小时内接受抗生素治疗的患者中，感染性休克患者每延迟 1 小时使用抗生素，死亡风险增加 35% (p = 0.042)，但在没有休克的患者中未观察到这种趋势。及时给予抗生素可改善感染性休克患者的预后；然而，在没有休克的脓毒症患者中，早期抗生素给药与结果之间的关联并不明确。