if you don't immediately know why this paper is garbage, then read this explanation (bit.ly/3klwkek). in short, time-to-intervention studies are retrospective correlational junk which continue to infest the scientific literature (rantorial #1/4)
https://twitter.com/accpchest/status/1305569065856045057
the data from this study actually suggest that early antibiotics in pneumonia are *bad*, but early antibiotics in septic shock are *good*. this obviously isn't true -it merely serves as an illustration of what happens when you conflate correlation with causality (rantorial #2/4) 
the study is funded and largely performed by Shionogi (a company producing - you guessed it - antibiotics!). this may explain their unbridled enthusiasm with the conclusion that early antibiotics will save the world (rantorial #3/4)
in fairness, I'm not suggesting that delaying antibiotic therapy is a good idea. but we should be intellectually honest about the lack of high-quality evidence in this area. repeated publication of time-to-intervention studies merely pollutes the scientific literature (#4/4)
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