{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:52:29Z","timestamp":1792626749182,"version":"4.5.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>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 <jats:italic>The Surviving Sepsis Campaign<\/jats:italic> from 2021 recommend administration of antimicrobials within one hour for suspected septic shock or high likelihood of sepsis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a comprehensive review of the literature regarding timing of antimicrobial administration and its impact on sepsis outcome, to evaluate whether a 1 h 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>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 1 h. However, other studies did not observe this linear association, instead reporting significantly increased mortality only after 3\u20136 h. These findings may indicate that a 1 h goal may not be optimal for all patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Based on the findings in this systematic review, the recommendations outlined in <jats:italic>The Surviving Sepsis Campaign<\/jats:italic> appear to be reasonable goals. For patients with febrile neutropenia, further research is necessary to determine the optimal timing for antimicrobial administration.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1597047","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T05:32:13Z","timestamp":1756791133000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Timing of antibiotic initiation in sepsis and neutropenic fever"],"prefix":"10.3389","volume":"12","author":[{"given":"Jenny","family":"Gretland","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrun","family":"Sj\u00f8m\u00e6ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Knut 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