Early Antibiotics Fail to Lower Death Risk in Palestinian ICU Sepsis Patients

Among intensive care patients with sepsis in the northern West Bank, receiving antibiotics within the first hour of recognition did not translate into better survival, according to a retrospective cohort study published in Annals of Clinical Microbiology and Antimicrobials. The finding challenges a widely held assumption in sepsis care, at least within this specific, resource-constrained setting, and points instead to illness severity and underlying health conditions as the dominant predictors of death.

The study included 297 adults admitted to intensive care units at two government hospitals with sepsis or septic shock between January 2023 and June 2025. Most participants were male, at 59.6 percent, and 76.1 percent were older than 60 years. The burden of disease in this cohort was striking: 69.7 percent of patients were in septic shock at admission, and the overall in-hospital mortality rate reached 71.4 percent, meaning nearly three in four patients died during the same hospital admission.

Researchers measured what they call door-to-antibiotic time, the interval from sepsis recognition to the start of the first intravenous antibiotic, and grouped patients into three categories: within one hour, between one and three hours, and after more than three hours. Antibiotics were started within an hour in 44.8 percent of cases, within one to three hours in 35.7 percent, and after more than three hours in 19.5 percent. These categories formed the main exposure variable in the analysis of survival.

Using binary logistic regression models, the team examined which factors independently predicted in-hospital mortality. Septic shock and the number of comorbidities emerged as significant predictors. Early antibiotic administration, by contrast, did not reach statistical significance, whether antibiotics were given within one hour, with an adjusted odds ratio of 0.68 and a 95 percent confidence interval of 0.38 to 1.22, or within three hours, with an adjusted odds ratio of 0.73 and a 95 percent confidence interval of 0.36 to 1.48. Because both confidence intervals cross 1, the data cannot rule out no effect of early timing on survival in this population.

At the bivariate level, only urinary tract infection was associated with delayed administration, with a p value of 0.038, while no other examined factors showed significant associations. In an ordinal logistic regression model, urinary tract infection remained the only independent predictor of delayed antibiotic administration, with an adjusted odds ratio of 0.55 and a 95 percent confidence interval of 0.35 to 0.88. The authors do not elaborate in the abstract on the direction of this association beyond reporting the estimate.

The context of the research matters. The authors note that sepsis management in low-resource, conflict-affected healthcare systems faces additional challenges that may worsen outcomes, and timely antibiotic administration is widely regarded as a cornerstone of sepsis treatment. Palestine’s health system, particularly in the northern West Bank where the two government hospitals were located, operates under precisely such constraints, which may shape both how quickly antibiotics can be given and what other factors drive mortality.

Despite the null finding on antibiotic timing, the authors draw practical conclusions for their setting. They argue that improving microbiology services, involving clinical pharmacists, and identifying local resistance patterns can strengthen antimicrobial stewardship and support empiric treatment decisions.

Several limitations should temper interpretation. As a retrospective cohort study at two hospitals, the analysis depends on the quality of recorded data and cannot establish causation between any exposure and outcome. The confidence intervals around the antibiotic-timing estimates are wide, leaving open the possibility of a moderate protective effect that the sample of 297 patients was not powered to detect. The extremely high mortality rate and the predominance of septic shock at admission also distinguish this cohort from many published sepsis studies, which may limit how far the findings generalize to settings with different case mixes. The results are best read as an observational association within one specific healthcare context, not as evidence that early antibiotics are universally unimportant in sepsis care.

Subject of Research: The association between early antibiotic administration and in-hospital mortality among ICU patients with sepsis in Palestine.

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

Article References: Sawalha, R., Aqqad, S., Taha, S., & Alkaiyat, A. (2026). Early antibiotic administration and in-hospital mortality among ICU patients with sepsis in Palestine: a retrospective study. Annals of Clinical Microbiology and Antimicrobials. https://doi.org/10.1186/s12941-026-00884-1

Image Credits: AI Generated

DOI: 10.1186/s12941-026-00884-1

Keywords: sepsis, septic shock, antibiotic timing, in-hospital mortality, intensive care, retrospective cohort study, Palestine, West Bank, antimicrobial stewardship, logistic regression, comorbidities, low-resource healthcare