Comprehensive Summary
This clinical trial evaluated the association between timing of antibiotic administration and mortality in emergency department (ED) patients with suspected sepsis. The authors performed a post hoc analysis of the 1-BED stepped-wedge cluster-randomized trial at 23 EDs in France and Spain, including 872 patients enrolled between June 2022 and September 2023. Of 859 patients with complete data, 58% received antibiotics within one hour of ED arrival.The study found that antibiotic administration beyond one hour was associated with significantly higher 28-day in-hospital mortality (14.7% vs. 9.6%; adjusted odds ratio [aOR] 2.00). Each hour of delay was associated with a 6% increase in mortality risk (aOR 1.06). This association remained significant among patients without hypotension.
Outcomes and Implications
This study underscores the importance of early antibiotic administration in suspected sepsis, including in patients without overt shock, supporting rapid antibiotic protocols in the ED. These findings have important implications for clinical practice, potentially influencing triage and care pathways. However, as a post hoc analysis, the study is subject to potential confounding and selection bias. Additionally, infection was suspected rather than confirmed, which complicates decisions regarding empiric antibiotic treatment. Although these results support current guideline recommendations, further research is needed to identify which patient populations derive the greatest benefit from immediate antibiotic administration.