Kumar 2006 Brief Summary – Delay in antibiotics increases septic shock mortality

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Summary of the Kumar 2006 Trial

Among patients with septic shock, every hour of delay in appropriate antibiotic administration was associated with a significant increase in mortality.

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Key Points from Kumar 2006

  • Retrospective cohort of 2,731 septic shock patients from the US and Canada
  • Study spanned from 1989-2004 (long time period introduces temporal confounding with changes in practice)
  • Onset of hypotension to first appropriate antibiotic very delayed (median 6 hrs, mean 13.5 hrs)
  • Overall mortality rate of 56.2% (very high for septic shock)
  • Every hour of delay resulted in a mean 7.6% increase in mortality (range 3.6-9.9%)
  • Interestingly, in patients who initiated antimicrobial before the onset of shock, mortality rates were quite high (52.2%) — roughly the same mortality rate as waiting 5-6 hours after the onset of shock


Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589-96. PMID 16625125

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