Delays From First Medical Contact to Antibiotic Administration for Sepsis

Crit Care Med. 2017 May;45(5):759-765. doi: 10.1097/CCM.0000000000002264.


Objective: To evaluate the association between total medical contact, prehospital, and emergency department delays in antibiotic administration and in-hospital mortality among patient encounters with community-acquired sepsis.

Design: Retrospective cohort study.

Setting: Nine hospitals served by 21 emergency medical services agencies in southwestern Pennsylvania from 2010 through 2012.

Patients: All emergency medical services encounters with community acquired sepsis transported to the hospital.

Measurements and main results: Among 58,934 prehospital encounters, 2,683 had community-acquired sepsis, with an in-hospital mortality of 11%. Median time from first medical contact to antibiotic administration (total medical contact delay) was 4.2 hours (interquartile range, 2.7-8.0 hr), divided into a median prehospital delay of 0.52 hours (interquartile range, 0.40-0.66 hr) and a median emergency department delay of 3.6 hours (interquartile range, 2.1-7.5 hr). In a multivariable analysis controlling for other risk factors, total medical contact delay was associated with increased in-hospital mortality (adjusted odds ratio for death, 1.03 [95% CI, 1.00-1.05] per 1-hr delay; p < 0.01), as was emergency department delay (p = 0.04) but not prehospital delay (p = 0.61).

Conclusions: Both total medical contact and emergency department delay in antibiotic administration are associated with in-hospital mortality in community-acquired sepsis.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / therapeutic use
  • Community-Acquired Infections
  • Emergency Medical Services / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Pennsylvania
  • Retrospective Studies
  • Risk Factors
  • Sepsis / drug therapy*
  • Sepsis / mortality*
  • Sex Factors
  • Time Factors
  • Time-to-Treatment / statistics & numerical data


  • Anti-Bacterial Agents