Evidence map›Paper›PMID 33784532›Full record

ArticleThe American journal of emergency medicine2021

The effect of delays in second-dose antibiotics on patients with severe sepsis and septic shock.

Joseph D Lykins V, Hani I Kuttab, Erron M Rourke, Michelle D Hughes, Eric P Keast, Jason A Kopec, Brooke L Ward, Natasha N Pettit, Michael A Ward

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 1 country.

Joseph D Lykins VDepartment of Emergency Medicine, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298, United States.
Hani I KuttabBerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States. Electronic address: hikuttab@medicine.wisc.edu.
Erron M RourkeSection of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, United States.
Michelle D HughesBerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States.
Eric P KeastDivision of Emergency Medicine, NorthShore University HealthSystem, Evanston, IL 60201, United States.
Jason A KopecDivision of Emergency Medicine, Carle Foundation Hospital, Urbana, IL 61801, United States.
Brooke L WardDepartment of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, United States.
Natasha N PettitDepartment of Pharmacy, University of Chicago, Chicago, IL 60637, United States.
Michael A WardBerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States.
University of Wisconsin–Madison · USUniversity of Chicago · USCarle Foundation Hospital · USNorthShore University HealthSystem · USUniversity Health System · US

Funding

The Institute for Translational MedicineUL1TR002389 · NCATS · UNIVERSITY OF CHICAGO · PI Joshua J Jacobs, DAVID O MELTZER · 2017 to 2026
$71.6M
NCATS NIH HHS UL1 TR002389
6 · The paper itself

Abstract

backgroundEarly antibiotics are fundamental to sepsis management. Second-dose antibiotic delays were associated with increased mortality in a recent study. Study objectives include: 1) determine factors associated with delays in second-dose antibiotic administration; 2) evaluate if delays influence clinical outcomes.

methodsED-treated adults (≥18 years; n = 1075) with severe sepsis or septic shock receiving ≥2 doses of intravenous antibiotics were assessed, retrospectively, for second-dose antibiotic delays (dose time > 25% of recommended interval). Predictors of delay and impact on outcomes were determined, controlling for MEDS score, 30 mL/kg fluids and antibiotics within three hours of sepsis onset, lactate, and renal failure, among others.

resultsIn total, 335 (31.2%) patients had delayed second-dose antibiotics. A total of 1864 second-dose antibiotics were included, with 354 (19.0%) delays identified by interval (delayed/total doses): 6-h (36/67) = 53.7%; 8-h (165/544) = 30.3%; 12-h (114/436) = 26.1%; 24-h (21/190) = 8.2%; 48-h (0/16) = 0%. In-hospital mortality in the timely group was 15.5% (shock-17.6%) and 13.7% in the delayed group (shock-16.9%). Increased odds of delay were observed for ED boarding (OR 2.54, 95% 1.81-3.55), shorter dosing intervals (6/8-h- OR 2.99, 95% CI 1.95-4.57; 12-h- OR 2.46, 95% CI 1.72-3.51), receiving 30 mL/kg fluids by three hours (OR 1.42, 95% CI 1.06-1.90), and renal failure (OR 2.57, 95% CI 1.50-4.39). Delays were not associated with increased mortality (OR 0.87, 95% CI 0.58-1.29) or other outcomes.

conclusionsFactors associated with delayed second-dose antibiotics include ED boarding, antibiotics requiring more frequent dosing, receiving 30 mL/kg fluid, and renal failure. Delays in second-dose administration were not associated with mortality or other outcomes.

Indexed as

Administration, IntravenousAdultAgedAged, 80 and overAnti-Bacterial AgentsDrug Administration ScheduleEmergency Service, HospitalFemaleHospital MortalityHumansMaleMiddle AgedRetrospective StudiesShock, SepticTime-to-TreatmentAnti-Bacterial AgentsAntibioticsEmergency Department boardingSepsisSepticShock

Identifiers

PMID33784532
PMCPMC8364855
OpenAlexW3137773154

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.