Table 3. Association and Correlation Between Hospital-Level Trends in Antimicrobial Timing for Patients With Sepsis and Hospital-Level Trends in Antimicrobial Prescribing^a.

Outcome	Spearman correlation, r	P value	Change in outcome per 1-h decrease in median time to first antimicrobial, % (95% CI)b	P value
Antimicrobial receipt
Within 12 h	0.072	.39	0.1 (−0.4 to 0.6)	.63
Within 24 h	0.075	.37	0.2 (−0.3 to 0.7)	.47
Within 48 h	0.083	.32	0.2 (−0.3 to 0.7)	.44
Days of antimicrobial therapy	0.004	.96	−0.7 (−5.9 to 4.5)c	.79
Receipt of broad-spectrum coveraged
Within 48 h
Spectrum Score ≥40	0.028	.73	0.008 (−0.3 to 0.3)	.95
Spectrum Score ≥45	0.064	.44	0.06 (−0.1 to 0.3)	.58
Within 30 d
Spectrum Score ≥40	0.066	.43	0.1 (−0.3 to 0.5)	.62
Spectrum Score ≥45	0.080	.34	0.1 (−0.2 to 0.5)	.53
Broadness of antimicrobial coverage
Within 48 h	0.056	.50	0.05 (−0.15 to 0.25)c	.61
Within 30 d	0.029	.73	0.03 (−0.20 to 0.25)c	.82

^a This table presents the correlation and association of hospital’s temporal trend in antimicrobial timing in patients with sepsis (ie, hospital trends shown in Figure 1) and antimicrobial prescribing trends among all hospitalized patients with systemic inflammatory response syndrome (SIRS). Conceptually, this analysis answers the question, as a hospital speeds up antimicrobial delivery for patients with sepsis, what is the association with broader antimicrobial prescribing trends among all patients with SIRS? A sensitivity analysis examining the association with trends in patients with SIRS but without sepsis is presented in eTable 5 in the Supplement. Data on antimicrobial receipt within 48 hours, days of antimicrobial therapy, and broadness of coverage within 48 hours are also presented visually in Figure 2.

^b Associations are shown for patients with sepsis and were determined from robust regression.

^c Data represent an absolute change of a continuous outcome, not a percentage change.

^d A Spectrum Score of 40 or higher would include coverage with piperacillin-tazobactam (Spectrum Score, 42.25), vancomycin plus piperacillin-tazobactam (Spectrum Score, 44.5), or similar, whereas a Spectrum Score of 45 or higher would include coverage with vancomycin plus a carbapenem (Spectrum Score, 45.25), or similar. For all antimicrobial prescribing trends assessed, there was no correlation and no association with trend in antimicrobial timing for sepsis. From 2013 to 2018, antimicrobial use declined. This table shows that trend of reduced antimicrobial use did not differ among hospitals with greater vs lesser declines in antimicrobial timing for sepsis. In short, speeding up time to antimicrobials with sepsis was not associated with increased antimicrobial use, and also not associated with impeding antimicrobial stewardship.