Less Obvious Sepsis Symptoms Linked to Antibiotic Delays

SEPSIS symptoms may shape antibiotic timing, while less obvious presentations can delay treatment and worsen 30-day outcomes.

Sepsis Antibiotic Timing Differs by Presentation

A cohort study of 29,647 adults hospitalized with community-onset presumed bacterial sepsis found that presenting symptoms were independently associated with how quickly patients received antibiotics.

Timely antibiotics were defined as administration within 3 hours of hospital presentation for patients with hypotension and within 5 hours for those without hypotension. Among patients with hypotension, 65.8% received antibiotics within the target window, compared with 76.5% of patients without hypotension.

Prehospital fever consistently favored faster treatment. It was associated with 34% higher adjusted odds of timely antibiotics among patients with hypotension and 26% higher odds among those without hypotension. By contrast, gastrointestinal symptoms were associated with lower odds of timely treatment in both groups.

Less Obvious Symptoms May Complicate Sepsis Recognition

Gastrointestinal symptoms were common, occurring in 42.3% of the cohort, but were not specific to one source of infection and frequently overlapped with other symptoms. Among patients without hypotension, urinary symptoms were associated with greater odds of timely antibiotics, while respiratory symptoms were associated with slightly lower odds.

The findings highlight the role of clinical history in early sepsis recognition. More than half of patients reported prehospital fever or fever symptoms, whereas only 22.7% had an objective temperature above 100.4 °F during the first 2 hours of hospital presentation. This suggests that relying on measured fever alone may miss an important clue to infection.

Timely Antibiotics Remain Linked to Lower Mortality

After adjustment for presenting symptoms, illness severity, and other patient characteristics, timely antibiotics were associated with lower 30-day mortality across the overall cohort. Adjusted mortality was 18.9% with timely treatment versus 21.0% with delayed treatment, an absolute difference of 2.10 percentage points.

Among patients without hypotension, timely treatment was also associated with lower mortality. The difference was not statistically significant when antibiotic timing was analyzed as a 3-hour threshold among patients with hypotension. However, continuous modeling showed a steeper increase in mortality as antibiotic delivery was delayed during the first 6 hours in this group.

The observational design cannot establish causality, and the cohort was limited to hospitals in Michigan. The findings support proactive sepsis screening when presentations are less obvious, particularly with gastrointestinal or respiratory symptoms.

Reference
Conlon A et al. Presenting symptoms and antibiotic timing among hospitalized adults with presumed sepsis. JAMA Netw Open. 2026;9(9).

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