Mok Katie, Christian Michael D, Nelson Sandra, Burry Lisa
, BScPhm, ACPR, RPh, is with Mount Sinai Hospital, Toronto, Ontario.
, MD, MSc, FRCP, is with Mount Sinai Hospital, Toronto, Ontario.
Can J Hosp Pharm. 2014 May;67(3):213-9. doi: 10.4212/cjhp.v67i3.1358.
Current evidence suggests that administration of appropriate antibiotic therapy within 1 h after the onset of hypotension significantly improves mortality rates among patients with severe sepsis and septic shock.
To determine the interval from recognition of severe sepsis or septic shock in inpatients to initial administration of antibiotic and to assess institutional compliance with the Surviving Sepsis Campaign's recommendation for early antibiotic therapy.
A 6-month retrospective chart analysis was conducted to determine the interval from documented onset of hypotension to initial administration of antibiotic for patients with severe sepsis or septic shock. Patients who were admitted to a general medicine ward, a surgery ward, or the intensive care unit (ICU) of a 475-bed university-affiliated hospital and who met the criteria for severe sepsis or septic shock were eligible for inclusion. Patients who received antibiotics before meeting the criteria for severe sepsis or septic shock were excluded.
Charts for 100 patients with severe sepsis or septic shock were reviewed. The mean age was 69.0 years (standard deviation 18.7 years), and 56% were men. The median interval from onset of severe sepsis or septic shock to administration of antibiotic was 4.00 h (interquartile range [IQR] 1.80-6.45 h). The median interval from the time a physician ordered an antibiotic to administration of the drug was 1.28 h (IQR 0.57-3.05 h). The interval between ordering and administration differed significantly for patients on the wards (5.67 h), those with onset in the ICU (4.00 h), and those with onset in the emergency department (3.28 h) (p = 0.039). The overall survival rate was 56%.
At the study hospital, the interval from onset of severe sepsis or septic shock to initial administration of antibiotic to inpatients exceeded the 1-h period recommended by the Surviving Sepsis Campaign. These results will be used as a baseline for future quality assurance and improvement initiatives aimed at minimizing the time to antibiotic administration for this group of patients, who are at high risk of death.
目前的证据表明，在低血压发作后1小时内给予适当的抗生素治疗可显著提高严重脓毒症和脓毒性休克患者的死亡率。
确定住院患者从确诊严重脓毒症或脓毒性休克到首次使用抗生素的时间间隔，并评估机构对脓毒症存活策略中早期抗生素治疗建议的依从性。
进行了一项为期6个月的回顾性图表分析，以确定严重脓毒症或脓毒性休克患者从记录的低血压发作到首次使用抗生素的时间间隔。入住一所拥有475张床位的大学附属医院普通内科病房、外科病房或重症监护病房（ICU）且符合严重脓毒症或脓毒性休克标准的患者纳入研究。在符合严重脓毒症或脓毒性休克标准之前接受抗生素治疗的患者被排除。
对100例严重脓毒症或脓毒性休克患者的病历进行了审查。平均年龄为69.0岁（标准差18.7岁），56%为男性。从严重脓毒症或脓毒性休克发作到使用抗生素的中位时间间隔为4.00小时（四分位间距[IQR]1.80 - 6.45小时）。从医生开出抗生素医嘱到用药的中位时间间隔为1.28小时（IQR 0.57 - 3.05小时）。病房患者、在ICU发作的患者和在急诊科发作的患者在医嘱开出和用药之间的时间间隔有显著差异（分别为5.67小时、4.00小时和3.28小时）（p = 0.039）。总生存率为56%。
在研究医院，住院患者从严重脓毒症或脓毒性休克发作到首次使用抗生素的时间间隔超过了脓毒症存活策略建议的1小时。这些结果将作为未来质量保证和改进措施的基线，旨在尽量缩短这类高死亡风险患者使用抗生素的时间。
