38-The Association Between Antibiotic Timing in Sepsis and Antibiotic Use for Potential Infection
Back to course
Video Transcription
Video Summary
Asset Subtitle
Sepsis, Pharmacology, 2021
Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Sarah Seelye

Introduction/Hypothesis: There are growing concerns that accelerating time-to-antibiotics in sepsis may result in treating more patients with antibiotics, including those without infection, and thereby contribute to antimicrobial resistance. To date, there is little evidence to support this claim. We sought to investigate whether hospital-level acceleration in antibiotic timing for sepsis is associated with increasing antibiotic use among patients hospitalized with potential infection.

Methods: We identified patients hospitalized at 132 Veterans Affairs (VA) hospitals (2013-2018) who were admitted via the emergency department (ED) with potential infection (defined as 2+ SIRS criteria) and sepsis (according to CDC's adult sepsis event definition). We fit multilevel linear models to estimate hospital-specific temporal changes in antibiotic timing among sepsis patients, adjusting for patient case-mix. Using slopes from the model, we classified hospitals into tertiles of antibiotic acceleration for sepsis. We also classified hospitals into tertiles of baseline antibiotic timing to account for floor and ceiling effects. In a second multilevel model, we measured temporal changes in the percentage of all potential infection patients receiving antibiotics within 48 hours of ED presentation. Using this model, we tested whether temporal changes in antibiotic use for potential infection differed by tertile of antibiotic acceleration for sepsis.

Results: Among 1,101,239 hospitalizations for potential infection in 132 VA hospitals, 2013-2018, 608,128 (55.2%) received antibiotics within 48 hours of ED presentation, and 117,435 (10.7%) met criteria for sepsis. The median time-to-antibiotics among sepsis hospitalizations declined from 5.2 hrs (IQR:3,8) in 2013 to 3.5 hrs (IQR:2,6) in 2018, with a majority of hospitals 111 (84.1%) accelerating time-to-antibiotics for sepsis. We found that the temporal change in antibiotic use in potential infection does not differ across the tertiles, χ2=5.98 (p=0.650).

Conclusions: There was marked acceleration in time-to-antibiotics for sepsis across VA hospitals from 2013-2018. However, we found no evidence that antibiotic acceleration in sepsis was associated with rising antibiotic use among hospitalizations for potential infection.


Meta Tag
Content Type Presentation
Knowledge Area Sepsis
Knowledge Area Pharmacology
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Antibiotics
Tag Infection
Year 2021
U.S. Veterans Affairs Healthcare System
accelerated antibiotic timing
antibiotic use
potential infection


Society of Critical Care Medicine

500 Midway Drive
Mount Prospect, IL 60056 USA

Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email: support@sccm.org

Contact Us

About SCCM


Advertising & Sponsorship




Patients & Families

Surviving Sepsis Campaign

Critical Care Societies Collaborative

kisspng-facebook-social-media-computer-icons-linkedin-soci-gray-5ac493cf1c2975.7867418415228323351154  - KW Symphony    Gray twitter 3 icon - Free gray social icons    Gray linkedin 3 icon - Free gray site logo icons    Gray instagram icon - Free gray social icons    YouTube Icon Gray Box - HONOR VETERANS NOW


© Society of Critical Care Medicine. All rights reserved.   |    Privacy Statement    |    Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.

Android App Download IOS App Download Powered By