Gabor Xantus1, Penny Allen2, Sharon Norman3, Peter Kanizsai4. 1. Tasmanian Health Service, North West. 2. Rural Clinical School, College of Health and Medicine, University of Tasmania, Burnie, Tasmania, Australia. 3. Centre for Medical Education, Cardiff University School of Medicine, Cardiff, Wales. 4. University Department of Emergency Medicine, University of Pecs, Pecs, Hungary.
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.
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.
Authors: J Villanueva; L Montes-Andujar; O V Baez-Pravia; E J García-Lamberechts; J González Del Castillo; A Ruiz; C Zurdo; J Barberán; J Menéndez; P Cardinal-Fernández Journal: Rev Esp Quimioter Date: 2020-08-05 Impact factor: 1.553
Authors: Noa Galtung; Eva Diehl-Wiesenecker; Dana Lehmann; Natallia Markmann; Wilma H Bergström; James Wacker; Oliver Liesenfeld; Michael Mayhew; Ljubomir Buturovic; Roland Luethy; Timothy E Sweeney; Rudolf Tauber; Kai Kappert; Rajan Somasundaram; Wolfgang Bauer Journal: Eur J Emerg Med Date: 2022-04-21 Impact factor: 4.106