OUTCOMES OF EARLY VS. DELAYED ANTIBIOTIC ADMINISTRATION IN SEPSIS MANAGEMENT: A META-ANALYSIS

Abstract

Background: Sepsis is a leading cause of mortality worldwide, accounting for approximately 20% of global deaths annually. Timely antibiotic administration is a cornerstone of sepsis management, with delays linked to higher mortality. Despite recommendations to initiate antibiotics within one hour of sepsis recognition, variability in definitions, timing thresholds, and patient outcomes complicates clinical decision-making. This meta-analysis synthesizes evidence on the impact of early versus delayed antibiotic administration on sepsis outcomes to provide evidence-based recommendations.

Objective: To evaluate the impact of early (<3 hours) versus delayed (>3 hours) antibiotic administration on mortality and secondary clinical outcomes in patients with sepsis or septic shock.

Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science identified 10 studies published between 2010 and 2022, encompassing 48,215 patients. Studies were included if they compared outcomes between early and delayed antibiotic administration in adult sepsis patients and reported on 28-day mortality or secondary outcomes. Data were extracted independently, pooled using random-effects models, and heterogeneity was assessed using the I² statistic. Subgroup and sensitivity analyses explored variations by sepsis severity and timing thresholds.

Results: Early antibiotic administration reduced 28-day mortality (pooled OR 0.72; 95% CI 0.64–0.81; p < 0.001) and was associated with shorter hospital stays (mean difference −3.2 days; 95% CI −4.1 to −2.3 days). Subgroup analysis showed greater mortality reduction in septic shock (OR 0.65; 95% CI 0.55–0.77). Heterogeneity was moderate (I² = 46%), with variations linked to study designs and timing definitions.

Conclusion: Early antibiotic administration significantly improves survival and clinical outcomes in sepsis, particularly in septic shock patients. These findings emphasize the need for timely intervention and standardized sepsis protocols to enhance patient outcomes globally.