Prehospital recognition of sepsis is associated with earlier antibiotic administration in the emergency department

BACKGROUND: Early antibiotic administration is crucial in the treatment of sepsis. The impact of prehospital sepsis recognition remains unclear. We investigated whether an emergency medical services (EMS) suspicion of sepsis was associated with earlier antibiotic administration after patients arrived at the emergency department (ED). METHODS: We conducted a retrospective, single-center observational cohort study involving adult patients (≥ 18 years) admitted via EMS between January 2022 and June 2025 with a sepsis diagnosis made in the ED. Prehospital sepsis recognition was defined as documentation of the term "sepsis" in the EMS protocol. The primary outcome was the percentage of patients who received antibiotic treatment within 1 h of ED admission. Logistic regression was used to adjust for age, sex, and illness severity (quick sequential organ failure assessment [qSOFA]). RESULTS: We included 134 patients (43% female; mean age 71 ± 15 years). The EMS suspected sepsis in 30 patients (22%). Among these, 63.3% received antibiotics within 1 h of ED admission, compared with 19.2% of patients without an EMS suspicion (p < 0.001). The median time to antibiotic administration was shorter in the EMS suspected group (32.0 min, interquartile range, IQR 16.5-76.8 min versus 124.5 min, IQR 72.5-211.5 min; p < 0.001). Prehospital sepsis suspicion was independently associated with antibiotic administration within 1h (adjusted odds ratio, OR 5.77, 95% confidence interval, CI 2.14-16.4; p < 0.001). CONCLUSION: Prehospital recognition of sepsis by EMS was strongly associated with earlier antibiotic treatment after ED admission. This highlights the potential of systematic sepsis detection in prehospital settings.