ArticleBMC emergency medicine2026
Optimal timing of antibiotics administration for sepsis or septic shock in the emergency department.
Article in BMC emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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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.
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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.
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Who cites it
2 citing papers in PubMed.
- ASP-COMPLEX: redefining antimicrobial stewardship to improve outcomes in high-risk patients with severe infections.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- Impact of an Emergency Triage Nursing Strategy on Early Recognition and Clinical Outcomes in Patients with Sepsis: A Single-Center Retrospective Pre-Post Case-Note Review.Journal of multidisciplinary healthcare · 2026Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesEarly antibiotic administration is considered an important component of sepsis management, yet the optimal time-to-antibiotics (T2A) remains uncertain. This study examined the association between T2A and in-hospital mortality among patients with sepsis and septic shock and explored how this relationship varies across different time intervals.
methodsWe conducted a retrospective cohort analysis of emergency department patients with sepsis from 1998 to 2022. Patients were dichotomized into two groups (T2A ≤ 1 h vs. T2A > 1 h), and clinical characteristics and mortality outcomes were compared. Cox proportional hazards models were used to assess the association between T2A and in-hospital mortality, adjusting for illness severity and other covariates. A non-linear Cox regression model was further applied to characterize the time-dependent relationship between T2A and mortality risk.
resultsA total of 15,317 patients were included. In-hospital mortality was 35.9% for patients receiving antibiotics within 1 h and 47.4% for those treated after 1 h (P < 0.001). After adjustment, T2A ≤ 1 h remained associated with lower mortality (adjusted HR = 0.936; 95% CI, 0.891–0.982). Non-linear modeling suggested that mortality risk was generally lower when antibiotics were administered within approximately 3 h, with the lowest estimated hazard observed at around 0.5 h; risk increased more noticeably beyond the 3-hour mark. These patterns were consistent across patients with and without septic shock.
conclusionIn this large retrospective cohort, shorter time-to-antibiotics was associated with lower in-hospital mortality, with the most favorable estimates occurring within the first hour and a gradual attenuation of benefit approaching 3 h. These findings provide insight into the time-dependent relationship between antibiotic administration and outcomes in sepsis that warrants further validation before being incorporated into clinical practice recommendations. CLINICAL TRIAL NUMBER: Not applicable.
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