Predictors of time to appropriate antibiotics for septic patients in intensive care units

This study assessed the amount of time that passed from diagnosis of sepsis to first administration of an appropriate antibiotic (TDFAA, hours). The aim of this study was to determine potential factors that affect TDFAA in patients admitted to intensive care units (ICUs), secondary to sepsis. Retrospective medical data and outcomes of patients with sepsis were assessed. Study outcomes included hospital and ICU mortality rates and morbidity severity, using factors such as ICU stay and duration of vasopressor use. Multivariate linear regression with stepwise model selection was performed to investigate factors associated with TDFAA. A total of 541 patients were included. Percentages of polymicrobial infections and multidrug-resistant organisms were higher with TDFAA of 24-48 hours than any other TDFAA (all P<0.001). Percentages of patients with prior antibiotic exposure were higher with TDFAA of 1-24 hours than any other TDFAA. Duration of previous antibiotic use was also significantly higher with TDFAA of >48 hours than any other TDFAA. After adjusting for other factors identified in stepwise model selection, TDFAA was longer in patients with multidrug-resistant organisms, septic shock, and increased Charlson comorbidity scores, as well as those on mechanical ventilation. Multidrug-resistant bacterial infections, comorbidities, mechanical ventilation, and septic shock were independent predictors of TDFAA. Therefore, careful administration, determination, and selection of antibiotic therapy are warranted for patients based on comorbidities and ventilator use, as well as the presence of septic shock.