Larochelle Joseph M, Morgan Jill A, Parbuoni Kristine A
University of Maryland School of Pharmacy and University of Maryland Medical Center Hospital for Children, Baltimore, Maryland.
J Pediatr Pharmacol Ther. 2009 Oct;14(4):221-5. doi: 10.5863/1551-6776-14.4.221.
The 2008 Surviving Sepsis Campaign guidelines state that intravenous antibiotic therapy should be started within the first hour of recognition of septic shock. Currently, there are no published studies looking at antibiotic timing in pediatric sepsis patients.
The purpose of this study is to determine if sepsis patients admitted to a Pediatric Intensive Care Unit (PICU) are administered antibiotics in the appropriate time frame according to the Surviving Sepsis Guidelines.
A retrospective chart review was conducted during a six-month time frame. For the purpose of this pilot study the onset of severe sepsis was defined as the time of a physician order for a vasopressor. Antibiotic appropriateness was based on culture results, drug dosing, and route. Length of PICU stay, overall hospital days, and mortality data were collected. Descriptive statistics on patient demographics, and the prescribing and time of administration of both antibiotics and vasopressors are included.
Fifty-four patients were identified, 4 of which were admitted twice during the study period. Fifty admissions did not meet criteria for analysis, with a final sample size of 8 patients identified. All patients were male with an average age of 7.6 years, average weight of 33.4 kg, and zero mortality rate. Eighty-eight percent of the patients were administered appropriate antibiotics. The average time from vasopressor order to the administration of antibiotics was 7 hours and 40 minutes.
The time delay in administering antibiotics to our pediatric sepsis patients likely involved physicians, nurses, and pharmacists. System improvements are needed to decrease the time delay in providing antibiotics to this patient population. Although our sample size was small, the mortality rate found in this study is lower than what has been reported in adults with sepsis.
2008年拯救脓毒症运动指南指出，应在识别脓毒性休克后的第一小时内开始静脉抗生素治疗。目前，尚无已发表的关于儿科脓毒症患者抗生素使用时机的研究。
本研究的目的是确定入住儿科重症监护病房（PICU）的脓毒症患者是否根据拯救脓毒症指南在适当的时间范围内使用抗生素。
在六个月的时间范围内进行了回顾性病历审查。在这项初步研究中，严重脓毒症的发作被定义为医生开出血管加压药医嘱的时间。抗生素的合理性基于培养结果、药物剂量和给药途径。收集了PICU住院时间、总住院天数和死亡率数据。包括了关于患者人口统计学、抗生素和血管加压药的处方及给药时间的描述性统计。
共识别出54例患者，其中4例在研究期间入院两次。50例入院患者不符合分析标准，最终确定的样本量为8例患者。所有患者均为男性，平均年龄7.6岁，平均体重33.4kg,死亡率为零。88%的患者使用了适当的抗生素。从开出血管加压药医嘱到使用抗生素的平均时间为7小时40分钟。
我们的儿科脓毒症患者使用抗生素存在时间延迟，这可能涉及医生、护士和药剂师。需要改进系统以减少向该患者群体提供抗生素的时间延迟。尽管我们的样本量较小，但本研究中发现的死亡率低于成人脓毒症患者的报告死亡率。
