Background. Inappropriate empiric antimicrobials could be a major cause of unfavorable mortality rates in co-morbid patients. This study aimed to assess the prevalence and impact of first-dose and 24-hour inappropriate antimicrobials on mortality rates of bacteremic septic patients. Methods. A retrospective cohort study was employed. Case record forms of patients diagnosed as sepsis, severe sepsis, or septic shock with positive hemoculture during 2009 were retrieved from the medical wards, Siriraj Hospital. Demographic data, antimicrobial use, types of bacteria isolated from blood and susceptibilities, patients’ comorbidities, 28-day and overall mortality rates were collected and analyzed. Results. There were 229 cases, mean age (SD) of 63.5 (17.2) years and mean (SD) APACHE II score of 24.7 (6.8). The prevalence of first-dose and 24-hour inappropriate antimicrobials was 29.7% and 25.3%, respectively. The 28-day and overall mortality rates between first-dose inappropriate and appropriate antimicrobial were 67.6% versus 60.2% ( ) and 75.0% versus 68.3% ( ), consequently. Patients with septic shock and inappropriate first-dose antimicrobials significantly had higher 28-day mortality rate (61.6% versus 41.9%; ). Conclusion. Higher mortality rates in bacteremic septic patients were substantially associated with inappropriate first-dose antimicrobials and 3-hour delayed antimicrobial administration after sepsis diagnosis. 1. Background Sepsis is one of the most serious conditions related to high mortality in approximately 0.1–5 per 100 cases admitted to the hospital, and it also accounts for 5–15 percent of cases with overall infections. In 2007, there were 201 (5.8%) cases diagnosed as sepsis from 3,451 patients admitted to the medical wards in the Siriraj Hospital, of which 38.8% developed septic shock. Inappropriate antimicrobial therapy administration during the first 24 hours was observed in 34.2%. The mortality rate of patients with sepsis and septic shock was as high as 34.3% and 52.6%, respectively [1]. Two important factors on antimicrobial therapy pertaining to adverse events and death in septic patients were the initiation of inappropriate antimicrobial therapy [2] and the delay of appropriate antimicrobial therapy [3]. Inappropriate empiric antimicrobial therapy was attributed to 46.5% of cases, with 35% overall mortality [3]. The elapsed time to appropriate antimicrobial therapy was crucial for the mortality in patients with severe sepsis and septic shock [4]. The Surviving Sepsis Campaign’s 2008 “International guidelines for the management of
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