Early Recognition of Sepsis Saves Lives, but a 1-Hour Antibiotic Target Misses the Mark

Sepsis is a dysregulated host response to infection that causes shock and multiorgan dysfunction.¹ Of the estimated 50 million people worldwide who develop sepsis annually, ∼10 million die, and survivors can have lasting or permanent organ damage.² Long-term effects include renal failure, cardiac damage, and neurocognitive dysfunction.^3–6 Quick recognition and resuscitation of sepsis including antibiotic administration has been championed by acute care and infectious disease specialties in both adult and pediatric medicine. In the pediatric population, there is some evidence to support these efforts, showing that shorter time to recognition of sepsis, initiation of treatment, and completion of a sepsis bundle lead to improved outcomes.^7–9 However, one component of many sepsis quality-improvement recommendations, the goal of antibiotic administration within an hour of sepsis recognition, is not well supported by available evidence and should be challenged.¹

Since 2004, the Surviving Sepsis Campaign’s “International Guidelines for Management of Sepsis and Septic Shock” have included a strong recommendation for administration of intravenous antibiotics within 1 hour of recognition of sepsis, citing published evidence that empirical antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour.^1,10,11 This recommendation has been applied to management of both children and adults despite an acknowledgment that “the feasibility with which clinicians may …