GI, Respiratory Symptoms Delay Sepsis Antibiotics

Patients presenting with community-onset presumed bacterial sepsis were less likely to receive timely antibiotic administration if they exhibited gastrointestinal (GI) or respiratory symptoms, according to an observational cohort study. The research, published in the Journal of Hospital Medicine, analyzed electronic health records from a large academic health system between January 1, 2018, and December 31, 2022. The study identified 15,872 adult patients with a diagnosis of sepsis within 24 hours of hospital admission, excluding those with healthcare-associated infections or prior antibiotic use within 30 days. Timely antibiotic administration was defined as receiving intravenous antibiotics within three hours of sepsis recognition, a benchmark recommended by the Surviving Sepsis Campaign.

Analysis revealed that patients with GI symptoms, such as nausea, vomiting, or diarrhea, were 1.2 times more likely to experience a delay in antibiotic administration compared to those without such symptoms. Similarly, patients with respiratory symptoms, including cough, shortness of breath, or hypoxia, faced a 1.15 times higher risk of delayed treatment. The study controlled for various confounding factors, including patient age, comorbidities, severity of illness scores (such as SOFA score), and the presence of a positive blood culture. Despite these controls, the association between these symptom clusters and delayed antibiotics persisted, suggesting a potential impact on clinical recognition or triage processes.

Researchers hypothesize that the non-specific nature of GI and respiratory symptoms might lead to a slower recognition of sepsis in these patients. These symptoms can overlap with a wide range of other common illnesses, potentially causing clinicians to consider sepsis lower on their differential diagnosis list initially. This diagnostic uncertainty could contribute to a longer time interval between symptom onset and the initiation of appropriate antibiotic therapy. The study authors emphasize that prompt antibiotic administration is critical for improving patient outcomes in sepsis, as delays are associated with increased morbidity, mortality, and longer hospital stays.

The findings underscore the importance of maintaining a high index of suspicion for sepsis, even in the presence of seemingly common or non-specific symptoms like those related to the GI or respiratory systems. The study recommends that healthcare systems review their sepsis screening protocols and consider incorporating specific prompts or decision support tools for patients presenting with these symptom clusters. Future research could explore the specific clinical pathways and decision-making processes that contribute to these delays and evaluate the effectiveness of targeted interventions aimed at improving timely sepsis recognition and treatment in these patient populations. The study did not identify specific patient demographics or hospital units that were disproportionately affected, focusing instead on the symptom presentation as the primary predictor of delay.