Sepsis Mortality Increases with Delays in Treatment

Sepsis bundles have been shown to decrease mortality (NEJM JW Emerg Med Oct 2012 and J Intensive Care Med 2012; 28:355). Early antibiotics, especially, are associated with a lower risk of severe sepsis progressing to septic shock (NEJM JW Emerg Med Apr 2017 and Crit Care Med 2017; 45:623). In 2013, New York instituted a 3-hour sepsis bundle (including blood cultures, serum lactate, and broad-spectrum antibiotics) for all hospitals. Using retrospective data for nearly 50,000 patients who presented with sepsis or septic shock to 149 hospitals in NY from 2014 to 2016, investigators evaluated the association between in-hospital mortality and time to completion of the sepsis bundle, time to administration of broad-spectrum antibiotics, and time to completion of the initial intravenous fluid bolus.

The bundle was completed on time for 83% of patients, with a median time to completion of 1.3 hours (interquartile range, 0.65 to 2.35 hours). Each additional hour until completion was associated with increased mortality (odds ratio, 1.04 per hour; 95% confidence interval, 1.02 to 1.05). The median time to antibiotic completion was 0.95 hours (IQR, 0.35 to 1.95 hours), and each hour delay was also associated with increased mortality (OR, 1.04 per hour). Finally, the median time to intravenous fluid bolus completion was 2.56 hours (IQR, 1.33 to 4.20 hours), but delay was not associated with increased mortality.