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Timing to antibiotic therapy in septic oncologic patients presenting without hypotension

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Abstract

Purpose

Sepsis accounts for only 2% of the hospitalizations worldwide but more than 17% of total in-hospital mortality. Inappropriate antimicrobial selection and delays in appropriate therapy have been associated with reduced survival in severe sepsis and septic shock. No studies to date have exclusively targeted septic oncologic patients without hypotension.

Methods

This study was a retrospective chart review of 100 adult cancer patients presenting to the emergency department with sepsis without hypotension. We investigated the effect of time to appropriate antibiotics on in-hospital mortality and hospital length of stay. It was hypothesized that increased time to antibiotic administration would worsen patient outcomes including in-hospital mortality and length of stay.

Results

Each 1-h delay in administration of appropriate antibiotic therapy increased the odds of in-hospital mortality by 16% (adjusted OR 1.16. 95% CI 1.04–1.34, p = 0.04). Time to appropriate antibiotics had no effect on hospital length of stay.

Conclusions

Time to appropriate antibiotics and in-hospital mortality were associated in this population of adult oncologic patients with sepsis without hypotension. Clinicians in the emergency department should strive to ensure the timely administration of a complete and appropriate empiric antibiotic regimen in septic patients with active cancer even in the absence of hypotension.

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Acknowledgments

The authors would like to thank Kelly Merriman, MPH, Ph.D., for her contributions over the course of the study.

Author information

Author notes

  1. Kathleen Morneau

    Present address: Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd (119), Houston, TX, 77030, USA

Authors and Affiliations

  1. Department of Pharmacy, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 90, Houston, TX, 77030, USA

    Kathleen Morneau, Frank Tverdek, Jeffrey Bruno & Katy M. Toale

  2. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1411, Houston, TX, 77030, USA

    Gary B. Chisholm

Authors
  1. Kathleen Morneau
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  2. Gary B. Chisholm
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Corresponding author

Correspondence to Kathleen Morneau.

Ethics declarations

The study was approved by the institutional review board, and the need for informed consent was waived.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Morneau, K., Chisholm, G., Tverdek, F. et al. Timing to antibiotic therapy in septic oncologic patients presenting without hypotension. Support Care Cancer 25, 3357–3363 (2017). https://doi.org/10.1007/s00520-017-3754-0

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  • DOI: https://doi.org/10.1007/s00520-017-3754-0

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