Lee Winnie, Liew Yixin, Chlebicki Maciej Piotr, Ong Sharon, Lee Pang, Kwa Andrea
Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore 169608.
Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore 169608.
Crit Care Res Pract. 2014;2014:479413. doi: 10.1155/2014/479413. Epub 2014 May 15.
Objective. To compare early empiric antifungal treatment with culture-directed treatment in critically ill patients with intra-abdominal sepsis. Methods. A prospective observational cohort study was conducted between August 2010 and July 2011, on SICU patients admitted after surgery for gastrointestinal perforation, bowel obstruction or ischemia, malignancy and anastomotic leakages. Patients who received antifungal treatment within two days of sepsis onset were compared to patients who received culture-directed antifungal treatment in terms of mortality rate and clinical improvement. Patients' demographics, comorbidities, severity-of-illness scores, and laboratory results were systematically collected and analysed. Results. Thirty-three patients received early empiric and 19 received culture-directed therapy. Of these, 30 from the early empiric group and 18 from culture-directed group were evaluable and analysed. Both groups had similar baseline characteristics and illness severity. Patients on empiric antifungal use had significantly lower 30-day mortality (P = 0.03) as well as shorter median time to clinical improvement (P = 0.025). Early empiric antifungal therapy was independently associated with survival beyond 30 days (OR 0.131, 95% CI: 0.018 to 0.966; P = 0.046). Conclusion. Early empiric antifungal therapy in surgical patients with intra-abdominal sepsis was associated with reduced mortality and warrants further evaluation in randomised controlled trials.
目的。比较早期经验性抗真菌治疗与针对培养结果的治疗在重症腹腔内脓毒症患者中的效果。方法。2010年8月至2011年7月，对因胃肠道穿孔、肠梗阻或缺血、恶性肿瘤及吻合口漏行手术后入住外科重症监护病房（SICU）的患者进行了一项前瞻性观察队列研究。将脓毒症发作后两天内接受抗真菌治疗的患者与接受针对培养结果的抗真菌治疗的患者在死亡率和临床改善方面进行比较。系统收集并分析患者的人口统计学资料、合并症、疾病严重程度评分及实验室检查结果。结果。33例患者接受了早期经验性治疗，19例接受了针对培养结果的治疗。其中，早期经验性治疗组30例、针对培养结果的治疗组18例可进行评估和分析。两组患者的基线特征和疾病严重程度相似。接受经验性抗真菌治疗的患者30天死亡率显著较低（P = 0.03），临床改善的中位时间也较短（P = 0.025）。早期经验性抗真菌治疗与30天以上的生存率独立相关（比值比0.131，95%可信区间：0.018至0.966；P = 0.046）。结论。外科腹腔内脓毒症患者早期经验性抗真菌治疗与死亡率降低相关，值得在随机对照试验中进一步评估。
