An observational study of 29,647 adults hospitalized with community-onset presumed bacterial sepsis found that certain presenting symptoms were associated with delays in antibiotic administration. Patients with gastrointestinal symptoms had lower odds of receiving timely antibiotics, regardless of whether they had hypotension. Respiratory symptoms were also linked to lower odds, but only in patients without hypotension.
The study, published in JAMA Network Open, defined timely antibiotics as within 3 hours for patients with hypotension and within 5 hours for those without. Overall, timely antibiotics were associated with a lower 30-day mortality rate (18.9% vs 21%). However, when broken down by blood pressure status, the survival benefit was significant only in non-hypotensive patients; the difference in hypotensive patients was not statistically significant, though the authors cautioned against interpreting this as evidence that timely antibiotics do not matter in that group.
An accompanying editorial noted that ambiguous presentations can mask sepsis and make diagnosis challenging. The editorialists suggested that GI symptoms may lead clinicians to consider common alternative diagnoses, and they emphasized the need to balance early antibiotic use with antibiotic stewardship, warning against overly aggressive protocols that could promote overdiagnosis.