The Impact of Time to Appropriate Antibiotic Therapy in Pneumonia Septic Shock
Bibliographic record
Abstract
Abstract Rationale: Pneumonia-associated septic shock (PaSS) is a leading cause of ICU mortality. This study aims to explore the impact of timing of appropriate antibiotic administration relative to the onset of persistent/recurrent hypotension on the outcomes in patients with (PaSS). Methods: A retrospective cohort study was conducted during periods from July 1989 to June 2018 across hospitals in the United States, Canada, and Saudi Arabia. This analysis includes 4,111 septic shock patients having pneumonia identified as the primary cause of infection. Univariate analysis was performed to evaluate the effect of delayed antibiotic treatment on survival to hospital discharge. Additionally, multivariable logistic regression was performed to identify variables associated with increased mortality in relation to antimicrobial delay. Results: Of the 4,111 patients identified with PaSS, 2,977 (72.4%) received appropriate antimicrobial therapy only after the onset of recurrent or persistent hypotension. In this subgroup, delayed initiation of appropriate antimicrobials was strongly correlated with in-hospital mortality (adjusted odds ratio [OR] 1.08 per hour delay, 95% [CI] 1.078-1.102, p < 0.0001). When effective antimicrobials were administered within the first hour post-hypotension onset, the patient survival rate was shown to be 76.4%, with each additional hour of delay up to 6 hours linked to an average reduction in in-hospital survival of approximately 5.9% per hour. After multivariate analysis including a selection of epidemiologic/therapeutic variables, the time to initiation of pathogen-appropriate antimicrobial therapy was demonstrated to be the most significant independent predictor of in-hospital mortality outcome. Conclusion: For adult patients with PaSS, delays in appropriate antimicrobial administration were associated with significant decreases in survival. Despite these results, only 59.2% of PaSS patients in this cohort received appropriate antimicrobial therapy within the first six hours following hypotension onset. Early recognition and treatment measures are central to improved outcomes in PaSS.
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".