Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan

Yutaka Umemura, Toshikazu Abe, Hiroshi Ogura, Seitato Fujishima, Shigeki Kushimoto, Atsushi Shiraishi, Daizoh Saitoh, Toshihiko Mayumi, Yasuhiro Otomo, Toru Hifumi, Akiyoshi Hagiwara, Kiyotsugu Takuma, Kazuma Yamakawa, Yasukazu Shiino, Taka Aki Nakada, Takehiko Tarui, Kohji Okamoto, Joji Kotani, Yuichiro Sakamoto, Junichi SasakiShin Ichiro Shiraishi, Ryosuke Tsuruta, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Gando

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6 Citations (Scopus)


Background The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle; however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients. Methods This was a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to intensive care units from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses. Results The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level, obtain blood cultures, administer broad-spectrum antibiotics, administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50%. In-hospital mortality was 18.0% in the patients with and 30.3% in the patients without bundle-adherent care (p = 0.054). The adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09–4.95) using propensity scoring. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour was related to in-hospital mortality (2.65 [95% CI 1.25–5.62] and 4.81 [95% CI 1.38–16.72], respectively). The adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04–1.57) by logistic regression analysis. Conclusion Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality.

Original languageEnglish
Article numbere0263936
JournalPloS one
Issue number2
Publication statusPublished - 2022 Feb

ASJC Scopus subject areas

  • General


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