Simran Gupta

@simrangmd.bsky.social

CCM fellow at Mount Sinai. Prior Transplant/Oncology ID fellow at Brigham and Women’s/Dana-Farber @mgb-id-fellows @harvardmed. former @MayoAZ_IMRES. @UConnHealth alum. Dog mom & dancer. 🇮🇳

My personal hobbyhorse is that Wegener's granulomatosis became granulomatosis with polyangiitis because Wegener was a Nazi so when Churg-Strauss syndrome became eosinophilic granulomatosis with polyangiitis many assumed incorrectly that Churg and Strauss (Jewish pathologists) were also Nazis.

The air is full of smoke, the food is full of parasites, and the water is full of data center bacteria but at least we stopped all that DEI children's cancer research!

🔥 In 39,842 sepsis cases, 1-3h vs 0-1h antibiotics ↑mortality in non-immunocompromised (OR 1.33) but not in immunocompromised (OR 1.08). Delay hurt septic shock pts only.⏳

Time to Antibiotics and Mortality in Immunocompromised versus Non-Immunocompromised Patients with Suspected Sepsis

Timely antibiotics are key determinants of sepsis survival and are presumed to be especially critical in immunocompromised patients. However, evidence supporting this assumption is limited.MethodsWe identified all adults treated for suspected sepsis in the emergency departments of nine U.S. hospitals, 2015-2024. We identified immunocompromised patients using diagnosis codes, supplemented with clinical data to define a severely immunocompromised subgroup. We used multivariable logistic regression to assess associations between time-to-antibiotics (primary analysis: 1-3 vs 0-1h; secondary analysis: 3-6 vs 0-3h) and in-hospital mortality, stratified by immune status and sepsis severity.ResultsAmong 39,842 hospitalizations with suspected sepsis, 20,721 occurred in non-immunocompromised patients and 19,121 in immunocompromised (2,283 severe). Overall, antibiotic administration at 1-3 vs 0-1h was associated with increased mortality in non-immunocompromised (OR 1.33, 95% CI 1.12-1.59) but not immunocompromised patients (OR 1.08, 95% CI 0.94-1.25). Increased risk was limited to septic shock, where delayed antibiotics were associated with higher mortality in both non-immunocompromised (OR 1.41, 95% CI 1.12–1.76) and immunocompromised patients (OR 1.21, 95% CI 1.002-1.47). In contrast, no association was observed in sepsis without shock regardless of immune status, including for antibiotic administrations at 3-6 vs 0-3h. Effect estimates were similar for mild-moderate and severe immunocompromise.ConclusionsShort delays in antibiotic administration were associated with increased mortality in septic shock but not in sepsis without shock, with no evidence of greater vulnerability among immunocompromised patients. These findings suggest antibiotic urgency should be guided primarily by clinical severity rather than immune competence.

academic.oup.com

Once I had a patient who was hypotensive despite 30cc/kg fluids and an ICU team member told me to give more fluids because the pt was only on 1L of oxygen. So I’m just wondering if anyone else tailors their resuscitation to whether or not they need to intubate said patient