Paper Chase 2 - In Sepsis, Time To ABX Matters

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Mark M., MD -

Agree that time and amount of fluids did not affect mortality or outcome.
The conclusion that the time to antibiotics "matters"may be overstated. The odds ratio is 1.04.
This just barely reached statistical significance with a p value of .05
This was a huge study but retrospective and therefore has some limits.
Prior to this study, a review of time to antibiotics revealed no benefit to faster antibiotics with OR of 1.16
(Sterling SA et al Crit Care Med 2015;43:1907-1915.)

I have no problem with trying to get antibiotics in as quick as possible for truly septic patients in whom a logical decision about source can be made. I fear that the message that "time is tissue" or that that to antibiotics "matter" is an overstated (and maybe wrong) hammer that will push protocols with kneejerk reactions for antibiotics--this results in overuse of antibiotics and overuse of broadspectrum antibiotics in patients who may not even need antibiotics much less broad spectrum. I think time to antibiotics "matters" is overstated and possibly wrong

-Mark Mosley MD (Wichita , KS)

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