Timing of antibiotic initiation in sepsis and neutropenic fever.

Introduction: Sepsis, as a life-threatening organ dysfunction caused by a dysregulated host response to infection, remains a leading cause of mortality worldwide. The condition requires rapid treatment, and Methods: We conducted a comprehensive review of the literature regarding timing of antimicrobial administration and its impact on sepsis outcome, to evaluate whether a 1 h target for initiating antibiotics is a reasonable goal. A literature search was conducted in the PubMed database, and we performed a narrative synthesis of the studies. Results: Of the 42 studies reviewed, 34 demonstrated a significant association between delayed time to first antibiotic and increased mortality rates. The majority of the studies found a significant increase in mortality with delays in antimicrobial initiation, particularly with hourly cutoffs. Discussion: Sepsis is a heterogeneous condition, complicating the establishment of universal guidelines. Approximately half of the studies identified a near-linear relationship between delayed antimicrobial treatment and increased mortality, emphasizing the benefit of administering antibiotics within 1 h. However, other studies did not observe this linear association, instead reporting significantly increased mortality only after 3-6 h. These findings may indicate that a 1 h goal may not be optimal for all patients. Conclusion: Based on the findings in this systematic review, the recommendations outlined in