The following is a summary of “Influence of antibiotic therapy with hemodynamic optimization on 30-day mortality among septic shock patients cared for in the prehospital setting,” published in the February 2024 issue of Emergency Medicine by Jouffroy, et al.

International guidelines recommend early implementation of treatment, including antibiotic therapy (ABT) and hemodynamic optimization, within 1 hour to reduce mortality in patients with septic shock. For a retrospective multicentric study, researchers sought to investigate the relationship between prehospital ABT delivered within the first hour, mean blood pressure (MAP) ≥ 65 mmHg at the end of the prehospital stage, and 30-day mortality among patients with septic shock.

From May 2016 to December 2021, patients with septic shock requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were retrospectively analyzed. The relationship between 30-day mortality and prehospital ABT delivered within the first hour and/or MAP ≥ 65 mmHg at the end of the prehospital stage was assessed using the Inverse Probability Treatment Weighting (IPTW) propensity score method.

Among the 530 patients included, 341 were male (64%) with a mean age of 69 ± 15 years. About 132 patients (25%) received prehospital ABT, among which 98 patients (74%) were treated with 3rd generation cephalosporin. Suspected pulmonary, urinary, and digestive infections were the most common causes of sepsis. The overall 30-day mortality rate was 31%. A significant association was observed between 30-day mortality rate and ABT administration within the first hour: RRa = 0.14 [0.04–0.55], ABT administration within the first hour associated with a MAP ≥ 65 mmHg: RRa = 0.08 [0.02–0.37], and ABT administration within the first hour in the prehospital setting associated with a MAP < 65 mmHg at the end of the prehospital stage: RRa = 0.75 [0.45–0.85]. Patients who received prehospital ABT after the first hour also had a 30-day mortality rate decrease: RRa = 0.87 [0.57–0.99], whereas patients who did not receive ABT had an increased 30-day mortality rate: RRa = 2.36 [1.89–2.95].

The study showed that pre-hospital ABT within the first hour and MAP ≥ 65 mmHg at the end of the prehospital stage are both associated with a decrease in 30-day mortality among patients suffering from septic shock cared for by a MICU. Further prospective studies were needed to confirm these preliminary results.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006186