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 degrees 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.