In this episode, I’ll discuss what phenotype of patients are most affected by delays in antibiotic therapy.
For patients with sepsis, the link between a delay in antibiotic therapy and increased risk of mortality is well-established.
However, it is possible that not all patients are affected the same way by delays in therapy. If a subgroup of patients could be identified that is most at risk for increased mortality from a delay in antibiotic therapy, that could help clinicians target efforts for more timely therapy.
In Critical Care Medicine researchers recently published a retrospective analysis titled Identifying High-Risk Subphenotypes and Associated Harms From Delayed Antibiotic Orders and Delivery. Over 60,000 patients at two tertiary care medical centers and four community-based hospitals were analyzed.
The authors identified a cluster of patients that were more likely to experience mortality after a delay in antibiotic therapy of more than 3 hours. These patients were more likely to be male, older, have CHF, HTN, DM, and were less likely to have a skin infection as the source of sepsis. In addition, these patients were more likely to have a high SOFA score on admission.
A lactate level above 2 mmol/L was determined to be the most important variable that identified patients at higher risk of mortality. This suggests that moving up a lactate measurement earlier in a patient’s care could identify those patients that are most likely to be affected by a delay in antibiotics. Such a strategy might focus attention on at-risk patients and cut down on indiscriminate antibiotic use that is sometimes employed in an effort to give patients antibiotics faster.
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Excelent comment! Thanks