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Research ArticleOriginal Article
Open Access

The impact of emergency antibiotic administration time on patients with sepsis

Saqer M. Althunayyan, Mohammed A. Aljanoubi, Sultan M. Alghadeer, Musab Z. Alharthi, Raied N. Alotaibi, Abdullah M. Mubarak and Abdulaziz M. Almutary
Saudi Medical Journal September 2021, 42 (9) 1002-1008; DOI: https://doi.org/10.15537/smj.2021.42.9.20210447
Saqer M. Althunayyan
From the Department of Trauma (Althunayyan, Alharthi); from the Department of Aviation and Marines (Aljanoubi); from the Department of Basic Sciences (Alotaibi, Mubarak), Prince Sultan College for EMS; from the Department of Clinical Pharmacy (Alghadeer), College of Pharmacy; and from the Emergency Department (Almutary), King Saud University, Riyadh, Kingdom of Saudi Arabia.
MBBS, SBEM
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  • For correspondence: [email protected]
Mohammed A. Aljanoubi
From the Department of Trauma (Althunayyan, Alharthi); from the Department of Aviation and Marines (Aljanoubi); from the Department of Basic Sciences (Alotaibi, Mubarak), Prince Sultan College for EMS; from the Department of Clinical Pharmacy (Alghadeer), College of Pharmacy; and from the Emergency Department (Almutary), King Saud University, Riyadh, Kingdom of Saudi Arabia.
BSc, MSc
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Sultan M. Alghadeer
From the Department of Trauma (Althunayyan, Alharthi); from the Department of Aviation and Marines (Aljanoubi); from the Department of Basic Sciences (Alotaibi, Mubarak), Prince Sultan College for EMS; from the Department of Clinical Pharmacy (Alghadeer), College of Pharmacy; and from the Emergency Department (Almutary), King Saud University, Riyadh, Kingdom of Saudi Arabia.
PharmD, BCPS
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Musab Z. Alharthi
From the Department of Trauma (Althunayyan, Alharthi); from the Department of Aviation and Marines (Aljanoubi); from the Department of Basic Sciences (Alotaibi, Mubarak), Prince Sultan College for EMS; from the Department of Clinical Pharmacy (Alghadeer), College of Pharmacy; and from the Emergency Department (Almutary), King Saud University, Riyadh, Kingdom of Saudi Arabia.
BSc
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Raied N. Alotaibi
From the Department of Trauma (Althunayyan, Alharthi); from the Department of Aviation and Marines (Aljanoubi); from the Department of Basic Sciences (Alotaibi, Mubarak), Prince Sultan College for EMS; from the Department of Clinical Pharmacy (Alghadeer), College of Pharmacy; and from the Emergency Department (Almutary), King Saud University, Riyadh, Kingdom of Saudi Arabia.
BSc, MSc
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Abdullah M. Mubarak
From the Department of Trauma (Althunayyan, Alharthi); from the Department of Aviation and Marines (Aljanoubi); from the Department of Basic Sciences (Alotaibi, Mubarak), Prince Sultan College for EMS; from the Department of Clinical Pharmacy (Alghadeer), College of Pharmacy; and from the Emergency Department (Almutary), King Saud University, Riyadh, Kingdom of Saudi Arabia.
BSc, MPH
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Abdulaziz M. Almutary
From the Department of Trauma (Althunayyan, Alharthi); from the Department of Aviation and Marines (Aljanoubi); from the Department of Basic Sciences (Alotaibi, Mubarak), Prince Sultan College for EMS; from the Department of Clinical Pharmacy (Alghadeer), College of Pharmacy; and from the Emergency Department (Almutary), King Saud University, Riyadh, Kingdom of Saudi Arabia.
MBBS, SBEM
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  • Article
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    - Flowchart illustrating the inclusion and exclusion criteria.

  • Figure 2
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    Figure 2

    - Illustrate the mortality rate among both groups for sepsis and severe sepsis patients.

Tables

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    Table 1

    - Characteristics of septic patients who received antibiotics within one hour versus those who received antibiotics between one and 3 hours.

    CharacteristicsOverall N=292Within 1 hour n=250Between 1 and 3 hours n=42P-value
    Mean age, years (±SD)56.3 (23.6)55.3 (23.8)61.2 (22.2)0.1754
    SBP <90 mmHg65 (22.3)58 (23.2)7 (16.7)0.9804
    Vasopressor use39 (13.4)34 (13.6)5 (11.9)0.0893
    Laboratory
    Creatinine, mean (±SD)186.1 (224.1)193.0 (233.8)144.8 (148.5)0.1593
    First lactate value, mmol/L, mean (±SD)3.4 (2.7)3.5 (2.7)3.0 (2.5)0.2937
    Leucocytosis (WBC >11) or leukopenia (<4)161 (55.1)142 (56.8)19 (45.2)0.1633
    Hospital mortality93 (31.8)79 (31.6)14 (33.3)0.8230
    Any comorbidities145 (49.6)123 (49.2)22 (52.4)0.7028
    Diabetes mellitus87 (29.8)86 (34.4)1 (2.4)<0.0001
    Hypertension101 (34.6)99 (39.6)2 (4.8)<0.0001
    Congestive heart failure12 (4.1)7 (2.8)5 (11.0)0.0059
    Kidney failure21 (7.2)19 (7.6)2 (4.8)0.5100
    Oncology19 (6.5)14 (5.6)5 (11.9)0.1253
    Source of infection
    Pneumonia empyema108 (37.0)106 (42.4)2 (4.8)<0.0001
    Urinary tract infection29 (9.9)23 (9.2)6 (14.3)0.3079
    Acute abdominal infection8 (2.7)7 (2.8)1(2.4)0.8776
    Meningitis14 (4.8)8 (3.2)6 (14.3)0.0019
    Skin/soft tissue infection32 (11)26 (10.4)6 (14.3)0.4557
    Bone/joint infection7 (2.4)1 (0.4)6 (14.3)<0.0001
    Wound infection7 (2.4)1 (0.4)6 (14.3)<0.0001
    Blood stream catheter infection7 (2.4)1 (0.4)6 (14.3)<0.0001
    • Values are presented as number and percentages (%). WBC: white blood cells, SBP: systolic blood pressure, SD: standard deviation

    • View popup
    Table 2

    - Type of antibiotic used in patients within one hour versus those who received antibiotics between one and 3 hours.

    Most common antibioticm, n (%)Overall N=292Within one hour n=250Between 1 and 3 hours n=42P-value
    FirstPiperacillin/Tazobactam 188 (42.3)Piperacillin/Tazobactam 116 (46.4)Ceftriaxone 17 (40.5)0.4756
    SecondCeftriaxone 137 (30.9)Ceftriaxone 74 (29.6)Piperacillin/Tazobactam 12 (28.57)0.8923
    ThirdVancomycin 45 (10.1)Vancomycin 31 (12.4)Vancomycin (5; 11.9)0.9280
    • Values are presented as number and percentages (%).

    • View popup
    Table 3

    - Characteristics of severe septic patients with systolic blood pressure <90 mmHg or mean arterial pressure <65 mmHg who received antibiotics within one hour versus those who received antibiotics between 1 and 3 hours (N=65).

    Characteristics of patientsWithin one hour n = 58Between 1 and 3 hours n = 7P-value
    Age59.86 (21.65)67.8 (21.58)0.5731
    Any comorbidities33 (56.9)5 (71.4)0.4611
    Diabetes mellitus22 (37.9)2 (28.6)0.463
    Hypertension25 (43.1)2 (28.6)0.309
    Congestive heart failure00NA
    Kidney failure4 (6.9)0NA
    Oncology14 (24.1)3 (42.8)0.287
    Source of infection
    Pneumonia empyema9 (15.5)1 (14.3)0.932
    Urinary tract infection5 (8.6)0NA
    Acute abdominal infection2 (3.4)0NA
    Meningitis12 (20.7)1(14.3)0.689
    Skin/soft tissue infection1 (1.7)0NA
    Bone/joint infection1 (1.7)0NA
    Wound infection1 (1.7)0NA
    Vasopressor18 (31.0)2 (28.6)0.894
    Mortality22 (37.9)3 (42.8)0.800
    • Values are presented as numbers and percentages (%).

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Saudi Medical Journal: 42 (9)
Saudi Medical Journal
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1 Sep 2021
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The impact of emergency antibiotic administration time on patients with sepsis
Saqer M. Althunayyan, Mohammed A. Aljanoubi, Sultan M. Alghadeer, Musab Z. Alharthi, Raied N. Alotaibi, Abdullah M. Mubarak, Abdulaziz M. Almutary
Saudi Medical Journal Sep 2021, 42 (9) 1002-1008; DOI: 10.15537/smj.2021.42.9.20210447

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The impact of emergency antibiotic administration time on patients with sepsis
Saqer M. Althunayyan, Mohammed A. Aljanoubi, Sultan M. Alghadeer, Musab Z. Alharthi, Raied N. Alotaibi, Abdullah M. Mubarak, Abdulaziz M. Almutary
Saudi Medical Journal Sep 2021, 42 (9) 1002-1008; DOI: 10.15537/smj.2021.42.9.20210447
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Keywords

  • antibiotics
  • sepsis
  • time to antibiotics
  • infection
  • emergency antibiotic

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