SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1597047
This article is part of the Research TopicSepsis Awareness Month 2024View all 6 articles
Timing of Antibiotic Initiation in Sepsis and Neutropenic Fever
Provisionally accepted
- 1University of Bergen, Bergen, Norway
- 2Department of Medicine, Haukeland University Hospital, Bergen, Hordaland, Norway
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Sepsis, as a life-threatening organ dysfunction caused by a dysregulated host response to infection, remains a leading cause of mortality worldwide. The condition requires rapid treatment, and The Surviving Sepsis Campaign from 2021 recommend administration of antimicrobials within one hour for suspected septic shock or high likelihood of sepsis.We conducted a comprehensive review of the literature regarding timing of antimicrobial administration and its impact on sepsis outcome, to evaluate whether a one-hour target for initiating antibiotics is a reasonable goal. A literature search was conducted in the PubMed database, and we performed a narrative synthesis of the studies.Of the 42 studies reviewed, 34 demonstrated a significant association between delayed time to first antibiotic and increased mortality rates. The majority of the studies found a significant increase in mortality with delays in antimicrobial initiation, particularly with hourly cutoffs. Discussion:Sepsis is a heterogeneous condition, complicating the establishment of universal guidelines.Approximately half of the studies identified a near-linear relationship between delayed antimicrobial treatment and increased mortality, emphasizing the benefit of administering antibiotics within one hour. However, other studies did not observe this linear association, instead reporting significantly increased mortality only after three to six hours. These findings may indicate that a one-hour goal may not be optimal for all patients.Based on the findings in this systematic review, the recommendations outlined in The Surviving Sepsis Campaign appear to be reasonable goals. For patients with febrile neutropenia, further research is necessary to determine the optimal timing for antimicrobial administration.
Keywords: sepsis1, Septic Shock2, Neutropenia3, Antibiotics4, Time-to-first-antibiotic5, Outcome6, mortality7, Surviving Sepsis Campaign8
Received: 20 Mar 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Sjømaeling, Gretland, Mosevoll and Reikvam. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Sigrun Sjømaeling, University of Bergen, Bergen, Norway
Jenny Gretland, University of Bergen, Bergen, Norway
Håkon Reikvam, University of Bergen, Bergen, Norway
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