Every year, sepsis affects nearly 50 million people worldwide [[1], [2], [3]] and leads to 11 million deaths [3]. One-third to one-half of all in-hospital deaths [4] are related to sepsis, whose which mortality rate is 30% even to 50 to 60% for septic shock, the most serious form of sepsis, despite of care improvements over the 30 past years [[5], [6], [7]]. The international guidelines [8,9] emphasize early recognition, severity assessment and treatment delivery to decrease sepsis related mortality [8]. For septic shock, international guidelines recommend antibiotic therapy (ABT) implementation within the first hour [[8], [9], [10]] because it is strongly associated with sepsis outcome [9,[11], [12], [13], [14], [15], [16], [17]]. On the other side, hemodynamic optimisation based on fluid volume expansion and norepinephrine infusion [9,18,19] with a target of mean arterial pressure (MAP) of at least 65 mmHg [8,20] is also recommended. In a previous study, among septic shock patients cared for by a mobile intensive care unit (MICU), we reported that prehospital ABT is associated with 30-day mortality decrease [11] but did not explore whether the delay of administration influenced outcome. Evidence based medicine also reported that prehospital hemodynamic optimisation is associated with a mortality decrease among septic shock patients cared for by a MICU [21,22].

In this study we investigated the relationship between ABT administration within the first hour and hemodynamic optimization in the prehospital setting and 30-day mortality among septic shock patients cared for by a MICU.