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LETTER TO THE EDITOR
Year : 2019  |  Volume : 1  |  Issue : 4  |  Page : 137-138

No Association between Earlier Antibiotic Administration and Reduction in In-Hospital Mortality in Patients with Severe Sepsis: We Are Not Sure


Department of ICU, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium

Date of Submission01-Jul-2020
Date of Acceptance20-Aug-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Patrick M Honore
Department of ICU, Centre Hospitalier Universitaire Brugmann-BrugmannUniversity Hospital, Place Van Gehuchtenplein, 41020 Brussels
Belgium
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DOI: 10.4103/jtccm.jtccm_7_20

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How to cite this article:
Honore PM, Mugisha A, Kugener L, Redant S, Attou R, Gallerani A, Bels DD. No Association between Earlier Antibiotic Administration and Reduction in In-Hospital Mortality in Patients with Severe Sepsis: We Are Not Sure. J Transl Crit Care Med 2019;1:137-8

How to cite this URL:
Honore PM, Mugisha A, Kugener L, Redant S, Attou R, Gallerani A, Bels DD. No Association between Earlier Antibiotic Administration and Reduction in In-Hospital Mortality in Patients with Severe Sepsis: We Are Not Sure. J Transl Crit Care Med [serial online] 2019 [cited 2021 Apr 18];1:137-8. Available from: http://www.tccmjournal.com/text.asp?2019/1/4/137/305782



Dear Editor,

We read with great interest the recent article by Abe et al. who conclude that they could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis.[1] We would like to make some comments. A recent systematic review based on 1552 abstracts concluded that patients with severe sepsis and septic shock should receive early and appropriate antibiotics in the emergency department.[2] Patients with septic shock who received appropriate antimicrobial therapy within 1 h of recognition had the greatest benefit in mortality.[2] Early administration of antibiotics is part of the sepsis care bundle advocated by the Surviving Sepsis Campaign guidelines;[3] appropriate source control also remains a key element.[4] We have no data to confirm or not whether source control was adequate in the majority of the patients in this study.[1] In a recent study by Martínez et al., when compared with patients who did not require source control, patients who underwent source control were older, with a greater prevalence of shock, major organ dysfunction, bacteremia, inflammatory markers, and lactic academia.[4] In addition, there was lower compliance with the resuscitation bundle in the source control group. Despite this, crude intensive care unit mortality (21.2% vs. 25.1%; P = 0.010) and hospital mortality (odds ratio, 0.809 [95% confidence interval, 0.658–0.994]; P = 0.044) were lower in those receiving source control.[4] Misdiagnosis of the site of infection, which is related to poor outcomes,[1] may have happened quite often in the Abe et al.'s study, although again, we have no data to confirm or not whether this occurred. Patients received broad-spectrum antibiotics, but no data was available regarding the appropriateness of the antibiotic prescribed.[1] In another study from the same group of Abe et al., the authors conclude that among patients with infection, misdiagnosed site of infection is associated with a >10% increase in in-hospital mortality.[5] Overall, considering all the potential confounders, we believe that this study remains inconclusive and we agree with the authors that a randomized controlled trial of this topic is needed.

Author's contributions

PMH, SR, and DDB designed the article. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

Acknowledgments

We would like to thank Dr. Melissa Jackson for critical review of the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abe T, Kushimoto S, Tokuda Y, Phillips GS, Rhodes A, Sugiyama T, et al. JAAM FORECAST group. Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: A descriptive analysis of a prospective observational study. Crit Care 2019;23:360.  Back to cited text no. 1
    
2.
Sherwin R, Winters ME, Vilke GM, Wardi G. Does early and appropriate antibiotic administration improve mortality in emergency department patients with severe sepsis or septic shock? J Emerg Med 2017;53:588-95.  Back to cited text no. 2
    
3.
Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Crit Care Med 2018;46:997-1000.  Back to cited text no. 3
    
4.
Martínez ML, Ferrer R, Torrents E, Guillamat-Prats R, GomÁG, Suárez D, et al. Impact of Source Control in Patients With Severe Sepsis and Septic Shock. Crit Care Med 2017;45:11-9.  Back to cited text no. 4
    
5.
Abe T, Tokuda Y, Shiraishi A, Fujishima S, Mayumi T, Sugiyama T, et al. JAAM SPICE study group. In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission. Crit Care 2019;23:202.  Back to cited text no. 5
    




 

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