Presumed Sepsis: Timely Antibiotics Linked to Lower Mortality

Presenting symptoms were associated with whether hospitalized adults with presumed bacterial sepsis received timely antibiotics, and timely treatment remained associated with lower 30-day mortality after adjustment for those symptoms, according to a cohort study published in JAMA Network Open.

Investigators analyzed 29,647 adults hospitalized with community-onset presumed bacterial sepsis at 67 hospitals in the Michigan Hospital Medicine Safety Consortium from November 2020 to May 2024. Timely antibiotics were defined as administration within 3 hours of presentation for patients with hypotension and within 5 hours for those without hypotension. Presenting symptoms were abstracted from clinician notes.

Among patients with hypotension, 65.8% received timely antibiotics, compared with 76.5% of those without hypotension. In adjusted analyses, prehospital fever was associated with higher odds of timely antibiotics in patients with hypotension (adjusted odds ratio [aOR], 1.34; 95% CI, 1.19-1.52) and without hypotension (aOR, 1.26; 95% CI, 1.17-1.35). Gastrointestinal symptoms were associated with lower odds in both groups (aOR, 0.84 and 0.80, respectively). Among patients without hypotension, urinary symptoms were associated with higher odds (aOR, 1.13) and respiratory symptoms with lower odds (aOR, 0.91).

After adjustment for presenting symptoms, timely antibiotics were associated with lower 30-day mortality in the overall cohort (18.9% vs 21.0%; adjusted absolute difference, −2.10 percentage points; 95% CI, −3.01 to −1.10) and among patients without hypotension. The association among patients with hypotension was not statistically significant, which the authors said may reflect the 3-hour cutoff; spline models showed a steep rise in mortality over the first 6 hours in this group.

The authors noted that the observational design leaves room for residual confounding, secondary associations were exploratory, the cohort was limited to Michigan, and symptom data depended on documentation quality. They said proactive sepsis screening in patients with less obvious presentations may promote timely recognition and treatment.

Source: Conlon A, Seelye S, Walzl E, et al. Presenting symptoms and antibiotic timing among hospitalized adults with presumed sepsis. JAMA Netw Open. 2026;9(9):e2635575. doi:10.1001/jamanetworkopen.2026.35575