The following is the summary of “Identifying high-risk phenotypes and associated harms of delayed time-to-antibiotics in patients with ICU onset sepsis: A retrospective cohort study” published in December 2022 issue of Critical Care by Hu, et al.

The goal of this study is to determine the characteristics of start sepsis in the intensive care unit (ICU) and the related effects of delayed time to treatment. The Medical Information Mart for Intensive Care IV (MIMIC-IV) database was used to locate individuals who developed sepsis after being admitted to the intensive care unit. The key exposure that was measured was the amount of time that passed between the detection of sepsis and the administration of the first antibiotic. 

Latent profile analysis, also known as LPA, was utilized in this study to identify phenotypes of sepsis based on individual organ failure score, which was generated from Sequential Organ Failure Assessment (SOFA). Researchers investigated how traits interacted with the time passed before antibiotics were administered. In the end analysis, there were 6,246 patients who participated. The overall mortality rate after 28 days was 12.7%. In patients who developed sepsis in the intensive care unit (ICU), a higher mortality rate at 28 days was associated with delayed access to antibiotics (HR 1.12, 95% CI 1.08–1.18). There are 4 distinct phenotypes of sepsis that have been identified: phenotype 1 is characterized by dysfunction in the respiratory system, phenotype 2 is characterized by dysfunction in the cardiovascular system, phenotype 3 is characterized by dysfunction in multiple organs, and phenotype 4 is characterized by dysfunction in the neurological system. 

In phenotype 1, the adjusted HR of 28-day mortality was 1.16 (95% confidence interval [CI]: 1.08–1.25), while in phenotype 2, it was 1.06 (95% confidence interval [CI]: 1.00–1.13). However, there was no significant interaction found. Patients with septic shock with respiratory or circulatory failure were more likely to suffer negative outcomes when antibiotic treatment was delayed.