{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:16:45Z","timestamp":1793143005382,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Early antibiotic administration is considered an important component of sepsis management, yet the optimal time-to-antibiotics (T2A) remains uncertain. This study examined the association between T2A and in-hospital mortality among patients with sepsis and septic shock and explored how this relationship varies across different time intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort analysis of emergency department patients with sepsis from 1998 to 2022. Patients were dichotomized into two groups (T2A\u2009\u2264\u20091\u00a0h vs. T2A\u2009&gt;\u20091\u00a0h), and clinical characteristics and mortality outcomes were compared. Cox proportional hazards models were used to assess the association between T2A and in-hospital mortality, adjusting for illness severity and other covariates. A non-linear Cox regression model was further applied to characterize the time-dependent relationship between T2A and mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 15,317 patients were included. In-hospital mortality was 35.9% for patients receiving antibiotics within 1\u00a0h and 47.4% for those treated after 1\u00a0h (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). After adjustment, T2A\u2009\u2264\u20091\u00a0h remained associated with lower mortality (adjusted HR\u2009=\u20090.936; 95% CI, 0.891\u20130.982). Non-linear modeling suggested that mortality risk was generally lower when antibiotics were administered within approximately 3\u00a0h, with the lowest estimated hazard observed at around 0.5\u00a0h; risk increased more noticeably beyond the 3-hour mark. These patterns were consistent across patients with and without septic shock.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In this large retrospective cohort, shorter time-to-antibiotics was\n                      <jats:italic>associated<\/jats:italic>\n                      with lower in-hospital mortality, with the most favorable estimates occurring within the first hour and a gradual attenuation of benefit approaching 3\u00a0h. These findings provide insight into the time-dependent relationship between antibiotic administration and outcomes in sepsis that warrants further validation before being incorporated into clinical practice recommendations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12873-026-01471-5","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T12:03:41Z","timestamp":1768824221000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimal timing of antibiotics administration for sepsis or septic shock in the emergency department"],"prefix":"10.1186","volume":"26","author":[{"given":"Ming-Shun","family":"Hsieh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan-Chih","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Hui","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian Chia-Rong","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Yuan","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chorng-Kuang","family":"How","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"1471_CR1","doi-asserted-by":"crossref","unstructured":"Dantes RB. 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The research was conducted according to the ethical guidelines of the Declaration of Helsinki. The patients\u2019 information was anonymized and de-identified before the analysis, and thus informed consent of the patients was waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"47"}}