ED nurse recognition of sepsis is critical to early administration of antibiotics in patients with sepsis to reduce mortality: A systematic review and meta-analysis

Dr Amy Johnston1, Dr Joon Park2, Professor Suhail  Doi3, Vicki  Sharman4, Justin  Clark5, Jemma  Robinson4, Professor Julia Crilly1

1Dept Emergency Medicine, Gold Coast Health and Menzies Health Institute Qld  , Southport, Australia, 2Dept Emergency Medicine, Gold Coast Health and The Prince Charles Hospital , Chermside, Australia, 3Research School of Population Health, Australian National University and College of Medicine, Qatar University, Doha, Qatar, Canberra, , Australia, 4Pharmacy Dept and Dept Emergency Medicine, Gold Coast University Hospital, Southport, Australia, 5Centre for Research in Evidence-Based Practice, Bond University , Southport, Australia

Background:  Sepsis is a time sensitive illness. Emergency department (ED) clinicians play an important role in the early recognition and management of sepsis. Part of sepsis management includes initiating broad spectrum antibiotics, ideally within the first hour of diagnosis. Despite various guidelines the evidence underpinning such recommendations remains limited. Understanding the extent to which early administration of antibiotics occurs in the ED and the impact this has on patient mortality warranted this review.

Purpose:  The goal of this review was to synthesize (pool) existing evidence regarding mortality for patients who present to the emergency department and are administered antibiotics immediately (≤1 hour) or later (>1 hour), and are diagnosed with sepsis.

Methods:  A search of databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL, using the MeSH descriptors “sepsis,” “systemic inflammatory response syndrome,” “mortality,” “emergency,” and “antibiotics,” was undertaken to identify studies that reported ‘time to antibiotic administration’ and mortality in patients with sepsis. Study data were extracted using a tailored data extraction form and all studies were evaluated for methodologic quality. From an initial pool of 582 possibly relevant studies, 10 studies had quantitative data for an overall meta-analysis. Three different statistical models were used to perform the meta-analysis.

Findings:    The pooled results suggest a significant, 33%, reduction in mortality odds for immediate (≤ 1 hour) compared with later (>1 hour) antibiotic administration (OR, 0.67 [95%CI, 0.59– 0.75]) in patients with sepsis.

Implications:   Immediate antibiotic administration (≤1 hour) seemed to reduce patient mortality, helping to provide an evidence-base for ED recommendations. This timeframe requires that informed and aware nurses contribute to early, comprehensive, sepsis management within the ED. ED nurses maintain their central role as a critical components in early detection and management of patients with suspected sepsis.


Amy Johnston is a conjoint research fellow in Emergency Care, based between Gold Coast Health and Menzies Health Institute Queensland/School of Nursing and Midwifery Griffith University. She is deeply committed to bringing research skills and outcomes to emergency staff and consumers. She is a widely published and cited academic and registered nurse with experience in a range of research techniques.