In breaking down the 3-hour bundle, the authors note that a longer time to antibiotics increases the risk of in-hospital mortality. The authors also broke out the other elements of the 3-hour bundle (blood cultures, lactate) and found a similar relationship, both in direction and magnitude, between time-to-draw and in-hospital mortality (figures s5 and s6).
With these results, can we say that there is anything 'special' about the administration of antibiotics? How can we determine what elements of the bundle are most important to accomplish early?
It is also notable that a large proportion of patients (~30%) had the protocol initiated outside of the ED. Any mortality difference as compared to those who started in the ED?
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