1Kumar et al. CCM. 2006:34:1589-96.

Cumulative Initiation of Effective Antimicrobial Therapy and Survival in

Septic Shock

time from hypotension onset (hrs)

0-0.

50.

5-11-

22-

33-

44-

55-

66-

99-

1212

-24

24-3

6

36+

frac

tion

of t

otal

pat

ient

s

0.0

0.2

0.4

0.6

0.8

1.0 survival fractioncumulative antibiotic initiation

2

Running Average Survival in Septic ShockBased on Antibiotic Delay (n=4195)

AbRx Delay (hrs)0 20 40 60 80 100

frac

tion

0.0

0.2

0.4

0.6

0.8

1.0

running average survivalcumulative fraction of total survivors

Funk and Kumar, Critical Care Clinics 2011 (in press)

3Kumar et al, CCM. 2006:34:1589-96.

Mortality Risk with Increasing Delays in Initiation of Effective Antimicrobial Therapy

Time (hrs)

1-1.

99

2-2.

99

3-3.

99

4-4.

99

5-5.

99

6-8.

99

9-11

.99

12-2

3.99

24-3

5.99

> 36

Od

ds

Ra

tio o

f De

ath

(95%

Co

nfid

en

ce In

terv

al)

1

10

100

4

Risk of Death with Increasing Antimicrobial

Delays: Subgroups

Kumar et al, CCM. 2006:34:1589-96. Adjusted Odds Ratio of Death

1.0 1.1 1.2 1.3

all

documented

suspected

culture +

culture -

bacteremia +

bacteremia -

community

nosocomial

gram +

gram -

fungal

respiratory

urinary tract

intra-abdominal

skin/soft tissue

1385

769

608

1546

459

1695

2154

N

912

1242

768

584

838

131

230

156

641

Survival = 0.79/1.119x

x = delay (hrs)