Delays in ED antibiotic initiation time are associated with clinically important increases in long-term, risk-adjusted sepsis mortality. This study investigated the association of door-to-antibiotic time with long-term mortality in ED patients with sepsis. This retrospective cohort study included nontrauma adult ED patients with clinical sepsis admitted to four hospitals from 2013 to 2017. Only patients’ first eligible encounter was included. Among 10,811 eligible patients, median door-to-antibiotic time was 166 min (interquartile range, 115-230 min), and 1-year mortality was 19%. After adjustment, each additional hour from ED arrival to antibiotic initiation was associated with a 10% (95% CI, 5-14; P < .001) increased odds of 1-year mortality.

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