News: GI, respiratory symptoms at presentation linked to antibiotic delays in presumed sepsis

Patients with community-onset presumed bacterial sepsis were less likely to get timely antibiotics if they had gastrointestinal (GI) or respiratory symptoms at the time of presentation, a recent study published in JAMA Network Open found.

In the analysis of nearly 30,000 patients, multivariable analysis showed that GI symptoms were associated with a lower odds of timely antibiotic receipt both in patients who had hypotension and those who did not. Respiratory symptoms, on the other hand, were linked to a lower likelihood only in the subset without hypotension, according to the findings.

While a majority of patients overall got timely antibiotics, it was more common in patients who presented without hypotension compared with those with hypotension (76.5% versus 65.8%). Thirty-day mortality rates with timely antibiotics were significantly lower in patients who weren’t hypotensive, but not in those with hypotension.

The delays were linked to hard outcomes; when accounting for symptoms at presentation, the patients who received timely antibiotics—within three hours for patients with hypotension and five hours for those without hypotension—had a lower 30-day mortality rate.

Symptoms associated with better odds of timely antibiotic receipt included prehospital fever, regardless of hypotension status and urinary symptoms in patients without hypotension.

While it may be tempting to respond to the study findings “with more aggressive protocols for earlier antibiotic administration for more patients, we must remember it is also the responsibility of the clinician to minimize overdiagnosis and practice good antibiotic stewardship,” researchers cautioned. “This careful balance is precisely what makes sepsis management so challenging.”

“These findings highlight the importance of a patient's clinical history in facilitating sepsis identification and treatment, and suggest that paying particular attention to patients with symptoms that may mask sepsis, such as GI and respiratory symptoms, may be helpful in early sepsis diagnosis,” the research team wrote.

Editor’s note: To read the full study, click here. To read additional coverage from MedPage Today, click here.