2300 Door-to-antibiotic time on mortality of admitted sepsis patients: systematic review and meta-analysis
Bibliographic record
Abstract
Aims and Objectives In 2021, the Surviving Sepsis Campaign International Guidelines advised clinicians to administer antimicrobials within 1h and 3h to sepsis patients with and without shock respectively. We aim to evaluate whether the timing of antibiotic administration in admitted sepsis patients affects mortality. Method and Design Studies published up to 19 May 2022 in PubMed, Ovid EMBASE, Web of Science, and Cochrane were included. Interventional and observational studies including adult human patients with suspected or confirmed sepsis and reported time of antibiotics administration with mortality were included. Risk of bias was assessed by Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Data were extracted and summary estimates were calculated using random-effects models. (PROSPERO: CRD42020137814). Results and Conclusion We included 43 articles (190,974 patients). Pooled OR for mortality for patients who received antibiotics ≤1h was 0.85 (95%CI:0.68-1.07) comparing with patients who received antibiotics >1h. Reductions in the risk of death in patients with earlier antibiotic administration were observed in patients at 3h (OR:0.80, 95%CI:0.68-0.95) and 6h (OR:0.58, 95%CI:0.39-0.86). In subgroup analysis of sepsis patients with shock, pooled ORs for mortality at the time points of 1, 3 and 6h h for antibiotic administration were 0.95(0.73-1.22), 0.80(0.64-1.01) and 0.77(0.84-1.11) respectively. Among sepsis patients without shock, the pooled ORs for mortality at the time points of 1, 3 and 6h h for antibiotic administration were 1.05(0.66-1.68), 1.27(1.05-1.53) and 0.53(0.38-0.74) respectively. Our findings suggest reduced mortality in sepsis patients with administration of antibiotics within 3h for all sepsis patients. In addition, our results do not support the current recommendations to administer antibiotics within 1h and 3h to sepsis patients with and without shock respectively. However, with limited numbers of articles in our subgroup analysis, further studies investigating the timing of antibiotics on mortality in sepsis patients with/without shock are required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.037 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".