Early Antibiotic Administration in Severe Sepsis and Septic Shock

Several retrospective studies have demonstrated improved survival when antibiotics are administered early in septic shock and severe sepsis. However, the results of the recent Protocolized Care for Early Septic Shock (ProCESS) trial have prompted intense debate in the critical care community regarding which elements of sepsis resuscitation bundles are most beneficial. Ferrer and colleagues sought to analyze the association between timing of antibiotic administration and mortality. The authors also evaluated whether an optimal time window for empiric antibiotic administration can be determined.

Using the database compiled for the Surviving Sepsis Campaign (SSC), the authors examined data entered between January 2005 and February 2010. Specifically, they analyzed data from 17,990 of 28,150 patients in the SSC database with severe sepsis and septic shock. They found that delay in antibiotic administration was associated with increased in-hospital mortality. As with any retrospective study, there is potential for residual confounding. In addition, appropriateness of antibiotics was not captured in this work. Despite these limitations, the strength of association demonstrated in this study appears to support current SSC guidelines.

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In the most recent issue of Critical Connections, SCCM President J. Christopher Farmer, MD, FCCM, also touches on the debate and controversy of the ProCESS trial.

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