door-to-antibiotic time and in-hospital mortality of elder patients presenting to emergency department with sepsis; a cross-sectional study

Introduction: the current international sepsis guideline recommends that administration of intravenous broad-spectrum antibiotics should be initiated within 1 hour of emergency department (ed) arrival for sepsis patients. this study aimed to evaluate the association between door-to-antibiotic time and in-hospital mortality of these patients.methods: in this retrospective cross-sectional study, elderly patients (age ≥65 years) diagnosed with sepsis in the ed of a tertiary referral and academic hospital from january to december 2019 were enrolled. door-to-antibiotic time was defined as the time from ed arrival to antibiotic initiation. the associations of door-to-antibiotic time and each hour delay in first antibiotic initiation with in-hospital mortality were assessed.results: six hundred patients with the median age of 78.0 (iqr: 72.0-86.0) were studied (50.8% female). the median door-to-antibiotic time was 51.0 (36.0 – 89.0) minutes and in-hospital mortality rate was 12.5%. there was no significant difference in the in-hospital mortality rate between door-to-antibiotic time ≤1 hour and >1 hour (13.1% vs. 11.6%, p = 0.726). when considering hour-upon-hour of door-to-antibiotic time, no significant difference in in-hospital mortality was observed (p = 0.866). factors that led to a delay in door-to-antibiotic time were presenting body temperature <38°c (odds ratio [or] 3.34; 95% ci, 2.12-5.29; p < 0.001) and age <75 years (or 1.7; 95% ci, 1.09-2.64; p = 0.019).conclusion: door-to-antibiotic time was not associated with in-hospital mortality in elderly sepsis patients in this study. significant factors that led to a delay in door-to-antibiotic time were no fever, age <75 years, doctor time, and blood sample taking time.