CHEST Guidelines-Duration-of-Symptoms-Prior-to-Antibiotic-Use,-and-

Duration-of-Symptoms-Prior-to-Antibiotic-Use,-and-

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A study conducted at the Hospital of Central Connecticut aimed to determine if the duration of symptoms before antibiotics administration (Ts) is a better predictor of outcomes in patients with acute infections than the timing of antibiotics indexed from hospital admission (Tr). The study followed 255 patients admitted with acute infections and found that Ts was significantly correlated with the length of hospital stay (LOS), as well as other variables such as the Simplified Acute Physiology Score (SAPS) II, age, and ICU transfers. Conversely, Tr did not show a significant association with LOS.<br /><br />The mean age of patients in the study was 64, with a hospital stay averaging 4.6 days. The median Ts to the first antibiotic dose was 30 hours. Patients requiring ICU transfers had longer hospital stays, with Ts over 48 hours and SAPS II scores above 30 indicating higher risk for extended stays.<br /><br />Risk groups were stratified into low, medium, and high, based on the presence of comorbidities and Ts duration. Results showed that mean LOS increased with the level of risk. The findings suggest that while Tr is commonly used in national quality measures for risk assessment, Ts may offer a more accurate prediction of morbidity and LOS, particularly when combined with other risk factors like comorbidities and SAPS scores.<br /><br />The authors argue that incorporating Ts and the number of comorbidities into existing risk-scoring tools could better identify patients at higher risk for longer hospital stays. The study extends previous observations limited to meningitis to broader infections, underscoring the potential of Ts in influencing patient outcomes. The authors acknowledge no conflicts of interest in their report.

Keywords

Hospital of Central Connecticut

acute infections

symptom duration

antibiotics timing

length of hospital stay

Simplified Acute Physiology Score

ICU transfers

comorbidities

risk assessment

patient outcomes