Appropriate timing of antibiotic initiation in patients with sepsis or septic shock: a systematic review and meta-analysis

Abstract

Evidence supporting antibiotic administration within 3 hours in sepsis without shock is limited. Therefore, we conducted a systematic review and meta-analysis to determine whether the timing of antibiotic initiation influences mortality in patients with sepsis or septic shock. We comprehensively searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and the Korean Medical Database from inception to November, 2022, using the keywords “sepsis,” “septic shock,” “anti-bacterial agents,” “time to treatment,” and “time factors.” Two reviewers independently performed eligibility screening and full-text review. Thirteen studies including 79,246 patients were analyzed: five prospective, seven retrospective, and one retrospective case–control study. In overall sepsis cases, mortality did not differ significantly between patients who received antibiotics within 1 hour and those in the delayed group but was significantly lower in those who received antibiotics within 3 hours than in those in the delayed group. In patients with septic shock, mortality was significantly lower in groups that received antibiotics within both 1 and 3 hours than in the delayed group. In septic shock, administration of antibiotics within 1 hour of diagnosis reduces mortality. In patients with sepsis, antibiotic administration within 3 hours, but not necessarily within 1 hour, was associated with reduced mortality.