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Impact of time-to-antibiotic administration on 1-year mortality in Veterans Affairs nosocomial acquired sepsis patients
De Los Santos, Bertha Alicia
De Los Santos, Bertha Alicia
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Abstract
Introduction: Sepsis is a major public health concern with 1.7 million cases annually in the United States and high in-hospital mortality. Research investigating long-term mortality following interventions for hospitalized sepsis patients is lacking. The purpose of this study is to evaluate the impact of antibiotic administration time on 1-year mortality in patients with nosocomial-acquired sepsis. Methods: This multicenter retrospective cohort study used data from the Veterans Affairs Corporate Data Warehouse. Patients who developed sepsis while admitted to a Veterans Health Administration hospital between January 1st, 2004 and December 31st, 2018 were included. Sepsis was identified using the Centers for Disease Control Adult Sepsis Event definition. The primary outcome was 1-year mortality, which was determined using comprehensive vital status information. Secondary outcomes included in-hospital, 30-day, 90-day and 180-day mortality. Time-to-antibiotic administration was determined from sepsis onset using barcode medication administration data. Multivariable modified Poisson regression models were used to assess the impact of time-to-antibiotic administration on 1-year mortality while controlling for patient age, race, gender, measures of comorbidity and severity of illness. Results: A total of 47,785 patients were identified with nosocomial-acquired sepsis. Among this cohort of patients, 17,199 (36%) died during the hospital stay and 29,161 (61%) died within 1-year. Median time-to-antibiotic administration from sepsis onset was 12.8 hours (interquartile range 6.2-21.1). After adjusting for covariates, time-to-antibiotic administration was not clinically meaningfully associated with 1-year mortality (Risk Ratio [RR] 0.997; 95% CI 0.996-0.997; p<0.0001). Subgroup analyses revealed similar results in patients with septic shock (RR 0.998; 95% CI 0.997-0.999; p<0.0001), ICU admission (RR 0.996; 95% CI 0.995-0.997; p<0.0001), and positive blood cultures (RR 0.996; 95% CI 0.995-0.997; p<0.0001). Conclusion: In this cohort of patients with nosocomial-acquired sepsis, we did not identify a clinically meaningful association between time-to-antibiotic administration and 1-year mortality. Antibiotic administration may have been expedited in patients who were the most critically ill. Future research is needed to better understand the role and influence of timely antibiotic administration among patients with nosocomial-acquired sepsis.
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2022-01-01
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University of Kansas
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Keywords
Health sciences, antibiotic, long-term, mortality, sepsis, septic shock, timing