Impact of Prehospital Antibiotics on in-Hospital Mortality in Emergency Medical Service Patients with Sepsis

Abstract

Background

Sepsis is a life-threatening medical condition that requires early recognition and timely management to improve patient outcomes and reduce mortality rates. Administering antibiotics in the prehospital setting can be effective to reduce the time to antibiotic therapy, which may be crucial for sepsis patients. However, the impact of prehospital antibiotics on mortality in sepsis patients remains uncertain, and the current evidence to support this practice in middle-income countries is particularly limited.

Methods

This was a single-center, retrospective-prospective cohort study aimed at determining the impact of prehospital antibiotics on in-hospital mortality rates among adult patients with sepsis. The study included patients who received care from the advanced level of Emergency Medical Service between June 2020 and October 2022 and compared the mortality rates of patients who received prehospital antibiotics with those of their counterparts who did not.

Results

In this study, 180 patients with a mean age of 71.6 ± 15.7 years were included, of whom 68.9% experienced respiratory infections. The results demonstrated that the prehospital antibiotic group had a significantly lower in-hospital mortality rate (32.2%) than the non-prehospital antibiotic group (47.8%; p=0.034). After adjusting for confounding factors, the odds ratio was 0.304 (95% CI: 0.11, 0.82; p=0.018), indicating a 69.6% lower incidence of in-hospital mortality in the prehospital antibiotic group. Furthermore, the prehospital antibiotic group received antibiotics significantly earlier (16.0 ± 7.4 minutes) than the non-prehospital group (50.9 ± 29.4 minutes; p<0.001).

Conclusion

This study provides evidence to support the administration of antibiotics to sepsis patients in the prehospital setting, as this practice can reduce mortality rates. However, larger, multicenter studies are required to confirm these findings and to further investigate the potential benefits of prehospital antibiotics in improving patient outcomes.

Keywords:

• sepsis
• prehospital
• emergency medical services
• antibiotic

Acknowledgments

The authors would like to express their gratitude to Rajavithi Hospital and the College of Medicine, Rangsit University, for their financial support for this research. The authors also acknowledge the assistance of the Department of Emergency Medicine and Narenthorn EMS center for providing access to the data used in this study, as well as Rajavithi Research Center staff for statistical analysis consultation and manuscript preparation. The authors extend their sincere appreciation to the emergency medicine residents, nurses, paramedics, and emergency medical technicians at Narenthorn EMS center for their participation in this research.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The College of Medicine, Rangsit University funded this research.