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Delays From First Medical Contact to Antibiotic Administration for Sepsis*

Seymour, Christopher W. MD, MSc1,2; Kahn, Jeremy M. MD, MSc1,2; Martin-Gill, Christian MD, MPH3; Callaway, Clifton W. MD, PhD3; Yealy, Donald M. MD3; Scales, Damon MD4; Angus, Derek C. MD, MPH1,2

doi: 10.1097/CCM.0000000000002264
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Objective: To evaluate the association between total medical contact, prehospital, and emergency department delays in antibiotic administration and in-hospital mortality among patient encounters with community-acquired sepsis.

Design: Retrospective cohort study.

Setting: Nine hospitals served by 21 emergency medical services agencies in southwestern Pennsylvania from 2010 through 2012.

Patients: All emergency medical services encounters with community acquired sepsis transported to the hospital.

Measurements and Main Results: Among 58,934 prehospital encounters, 2,683 had community-acquired sepsis, with an in-hospital mortality of 11%. Median time from first medical contact to antibiotic administration (total medical contact delay) was 4.2 hours (interquartile range, 2.7–8.0 hr), divided into a median prehospital delay of 0.52 hours (interquartile range, 0.40–0.66 hr) and a median emergency department delay of 3.6 hours (interquartile range, 2.1–7.5 hr). In a multivariable analysis controlling for other risk factors, total medical contact delay was associated with increased in-hospital mortality (adjusted odds ratio for death, 1.03 [95% CI, 1.00–1.05] per 1-hr delay; p < 0.01), as was emergency department delay (p = 0.04) but not prehospital delay (p = 0.61).

Conclusions: Both total medical contact and emergency department delay in antibiotic administration are associated with in-hospital mortality in community-acquired sepsis.

1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

2Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.

3Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

4Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada.

*See also p. 907.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Supported, in part, by a grant from the National Institutes of Health (primary investigator: Dr. Seymour, K23GM104022).

Dr. Seymour’s institution received funding from the National Institutes of Health (NIH)/National Institute of General Medical Sciences. He received funding from Beckman Coulter, Cytovale, and Edwards. He received support for article research from the NIH. Dr. Kahn’s institution received funding from U.S. Department of Health and Human Services (NIH and Health Resources & Services Administration) and Gordon and Betty Moore Foundation. Dr. Callaway received support for article research from NIH. Dr. Yealy received funding from American College of Emergency Physicians (editorial stipend), Lippincott (royalties), UpToDate (royalties), Oxford University Press (royalties), and from multiple legal firms (expert opinion). Dr. Scales institution received funding from Canadian Institute for Health Research (operating grants). He received funding from Physicians’ Services Incorporated Foundation (Fellowship in Translational Health Research). Dr. Angus received funding from Bayer HealthCare, Ferring Pharmaceuticals, and GlaxoSmithKline. Dr. Martin-Gill has disclosed that he does not have any potential conflicts of interest.

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