Early antibiotic administration and in-hospital mortality among ICU patients with sepsis in Palestine: a retrospective study

Timely antibiotic administration is a cornerstone of sepsis management. Especially in low-resource, conflict-affected healthcare systems, sepsis management faces additional challenges that may worsen outcomes. This study aimed to assess the association between early administration of antibiotics and in-hospital mortality among ICU patients with sepsis in Palestine. This was a retrospective cohort study conducted at two government hospitals in the northern West Bank. Adult patients admitted to ICUs with sepsis or septic shock between January 2023 and June 2025 were included. The primary outcome was in-hospital mortality, defined as death during the same hospital admission. The main exposure variable was door-to-antibiotic time, defined as the interval from sepsis recognition to the initiation of the first intravenous antibiotic (≤ 1, 1–3, and > 3 h). An ordinal logistic regression model was used to identify independent predictors of delayed antibiotic initiation. Furthermore, two binary logistic regression models were used to identify predictors of in-hospital mortality. Of the included 297 participants, 59.6% were males and 76.1% were aged older than 60 years. The prevalence of septic shock at admission was 69.7%, and the in-hospital mortality rate was 71.4%. Antibiotics were administered within an hour in 44.8%, within one to three hours in 35.7%, and after more than three hours in 19.5% of cases. At the bivariate level, only urinary tract infection (UTI) was associated with delayed antibiotic administration ( p = .038), while no other factors demonstrated significant associations. In the ordinal regression model, UTI remained the only predictor of delayed antibiotic administration (aOR = 0.55, 95% CI: 0.35–0.88). Moreover, septic shock and the number of comorbidities were independent predictors of in-hospital mortality, while early antibiotic administration did not demonstrate statistical significance, neither when administered within one hour (aOR = 0.68, 95%-CI: 0.38–1.22) nor within three hours (aOR = 0.73, 95%-CI: 0.36–1.48). Early antibiotic administration was not associated with improved survival among ICU patients with sepsis. However, in-hospital mortality was associated with septic shock and the number of comorbidities. Improving microbiology services, involving clinical pharmacists, and identifying local resistance patterns can improve antimicrobial stewardship and support empiric decisions. Additionally, developing contextual standards can improve early recognition and effective management of sepsis.