Although the 2018 SSC bundle recommends antibiotics within one hour of emergency department triage, this has not been adopted by the Centers for Medicare and Medicaid Services (CMS), and there are limited supportive data.
A recent study reported an 8 percent increased progression to septic shock from severe sepsis for every hour antibiotics were delayed from triage.9 The potential to mitigate disease progression through early intervention is a core emergency medicine principle. However, prior to operationalization, the difference between retrospective sepsis database evaluations and clinical implementation should be considered. Observational and retrospective evaluation of prospectively collected data support early antibiotic administration impact as life-saving in septic shock patients.
However, benefit is less clear in less acutely ill patients. In the New York study, there was an hourly mortality benefit for treatment after diagnosis for septic shock. However, for severe sepsis, the confidence initiated with one, making the association with an hourly mortality benefit less clear.