经验性抗生素治疗从第一小时起即可降低严重脓毒症和脓毒性休克的死亡率：基于指南的绩效改进项目结果

Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program.

作者信息

Ferrer Ricard, Martin-Loeches Ignacio, Phillips Gary, Osborn Tiffany M, Townsend Sean, Dellinger R Phillip, Artigas Antonio, Schorr Christa, Levy Mitchell M

机构信息

1Department of Intensive Care, Mútua Terrassa University Hospital, CIBER Enfermedades Respiratorias, Barcelona, Spain. 2Critical Care Center, Sabadell Hospital, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain. 3The Ohio State University Center for Biostatistics, Columbus, OH. 4Department of Surgery and Emergency Medicine, Division of Acute Care Surgery, Surgical/Trauma Critical Care, Barnes Jewish Hospital, Washington University, St. Louis, MO. 5California Pacific Medical Center, San Francisco, CA. 6Brown University/Rhode Island Hospital, Providence, RI. 7Cooper University Hospital, Camden, NJ.

出版信息

Crit Care Med. 2014 Aug;42(8):1749-55. doi: 10.1097/CCM.0000000000000330.

DOI:10.1097/CCM.0000000000000330

PMID:24717459

Abstract

OBJECTIVES

Compelling evidence has shown that aggressive resuscitation bundles, adequate source control, appropriate antibiotic therapy, and organ support are cornerstone for the success in the treatment of patients with sepsis. Delay in the initiation of appropriate antibiotic therapy has been recognized as a risk factor for mortality. To perform a retrospective analysis on the Surviving Sepsis Campaign database to evaluate the relationship between timing of antibiotic administration and mortality.

DESIGN

Retrospective analysis of a large dataset collected prospectively for the Surviving Sepsis Campaign.

SETTING

One hundred sixty-five ICUs in Europe, the United States, and South America.

PATIENTS

A total of 28,150 patients with severe sepsis and septic shock, from January 2005 through February 2010, were evaluated.

INTERVENTIONS

Antibiotic administration and hospital mortality.

MEASUREMENTS AND MAIN RESULTS

A total of 17,990 patients received antibiotics after sepsis identification and were included in the analysis. In-hospital mortality was 29.7% for the cohort as a whole. There was a statically significant increase in the probability of death associated with the number of hours of delay for first antibiotic administration. Hospital mortality adjusted for severity (sepsis severity score), ICU admission source (emergency department, ward, vs ICU), and geographic region increased steadily after 1 hour of time to antibiotic administration. Results were similar in patients with severe sepsis and septic shock, regardless of the number of organ failure.

CONCLUSIONS

The results of the analysis of this large population of patients with severe sepsis and septic shock demonstrate that delay in first antibiotic administration was associated with increased in-hospital mortality. In addition, there was a linear increase in the risk of mortality for each hour delay in antibiotic administration. These results underscore the importance of early identification and treatment of septic patients in the hospital setting.

摘要

目的

有力证据表明，积极的复苏集束治疗、充分的源头控制、恰当的抗生素治疗及器官支持是脓毒症患者治疗成功的基石。开始恰当抗生素治疗的延迟已被视为死亡风险因素。对脓毒症存活策略数据库进行回顾性分析，以评估抗生素给药时机与死亡率之间的关系。

设计

对为脓毒症存活策略前瞻性收集的大型数据集进行回顾性分析。

设置

欧洲、美国和南美洲的165个重症监护病房。

患者

评估了2005年1月至2010年2月期间共28150例严重脓毒症和脓毒性休克患者。

干预措施

抗生素给药及医院死亡率。

测量指标及主要结果

共有17990例患者在脓毒症确诊后接受了抗生素治疗并纳入分析。整个队列的院内死亡率为29.7%。首次抗生素给药延迟时间与死亡概率呈显著统计学增加。经严重程度（脓毒症严重程度评分）、重症监护病房入院来源（急诊科、病房与重症监护病房）及地理区域校正后的医院死亡率在抗生素给药时间达1小时后稳步上升。无论器官衰竭数量如何，严重脓毒症和脓毒性休克患者的结果相似。