Associations between paracetamol administration and delayed intravenous antibiotic administration among patients with in-hospital sepsis.

Abstract

Timely antibiotic administration is crucial for improving sepsis outcomes, but delays are common and multifactorial. Fever, a key feature of sepsis, is often treated with paracetamol, which may mask the condition and contribute to delays in time to antibiotic. This study investigated the association between paracetamol and delayed antibiotic administration in hospitalized septic patients. This was a retrospective study using data from a prospectively collected sepsis registry. The study was conducted at Songklanagarind Hospital, a quaternary care university-affiliated hospital in southern Thailand. Adult patients (≥15 years) admitted for ≥24 h who developed suspected sepsis between March 2023 and March 2024. Suspected sepsis was defined by a high National Early Warning Score (NEWS). We recorded paracetamol administration within 8 hours prior to the sepsis trigger (time zero). The primary outcome was the delay of ≥180 min from time zero to antibiotic administration. Logistic regression was used to assess the associations, adjusting for confounders. Among the 1634 sepsis events, 12.5% involved prior paracetamol use. Paracetamol administration was not associated with increased odds of delayed antibiotic treatment (adjusted odds ratio 1.29, 95% confidence interval 0.94-1.78, p = .12). It also did not affect the temperature trajectories. Higher temperature was associated with lower in-hospital mortality in patients who did not receive paracetamol but this association was reversed in those receiving paracetamol. In this study, paracetamol administration before a sepsis alert was not associated with a delay in antibiotic administration and did not affect temperature changes.