Han Moonjoo, Fitzgerald Julie C, Balamuth Fran, Keele Luke, Alpern Elizabeth R, Lavelle Jane, Chilutti Marianne, Grundmeier Robert W, Nadkarni Vinay M, Thomas Neal J, Weiss Scott L
*Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania †Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania ‡McCourt School of Public Policy and Department of Government, Georgetown University, Washington DC §Division of Emergency Medicine, Department of Pediatrics, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois ||Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania ¶Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania #Division of Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Penn State University College of Medicine, Hershey, Pennsylvania.
Shock. 2017 Jul;48(1):29-35. doi: 10.1097/SHK.0000000000000833.
Delayed antimicrobial therapy in sepsis is associated with increased hospital mortality, but the impact of antimicrobial timing on long-term outcomes is unknown. We tested the hypothesis that hourly delays to antimicrobial therapy are associated with 1-year mortality in pediatric severe sepsis.
Retrospective observational study.
Quaternary academic pediatric intensive care unit (PICU) from February 1, 2012 to June 30, 2013.
One hundred sixty patients aged ≤21 years treated for severe sepsis.
None.
We tested the association of hourly delays from sepsis recognition to antimicrobial administration with 1-year mortality using multivariable Cox and logistic regression. Overall 1-year mortality was 24% (39 patients), of whom 46% died after index PICU discharge. Median time from sepsis recognition to antimicrobial therapy was 137 min (IQR 65-287). After adjusting for severity of illness and comorbid conditions, hourly delays up to 3 h were not associated with 1-year mortality. However, increased 1-year mortality was evident in patients who received antimicrobials ≤1 h (aOR 3.8, 95% CI 1.2, 11.7) or >3 h (aOR 3.5, 95% CI 1.3, 9.8) compared with patients who received antimicrobials within 1 to 3 h from sepsis recognition. For the subset of patients who survived index PICU admission, antimicrobial therapy ≤1 h was also associated with increased 1-year mortality (aOR 5.5, 95% CI 1.1, 27.4), while antimicrobial therapy >3 h was not associated with 1-year mortality (aOR 2.2, 95% CI 0.5, 11.0).
Hourly delays to antimicrobial therapy, up to 3 h, were not associated with 1-year mortality in pediatric severe sepsis in this study. The finding that antimicrobial therapy ≤1 h from sepsis recognition was associated with increased 1-year mortality should be regarded as hypothesis-generating for future studies.
脓毒症患者延迟使用抗菌药物治疗与医院死亡率增加相关，但抗菌药物使用时机对长期预后的影响尚不清楚。我们检验了以下假设：小儿严重脓毒症患者每延迟一小时使用抗菌药物治疗，其1年死亡率就会增加。
回顾性观察研究。
2012年2月1日至2013年6月30日期间的四级学术性儿科重症监护病房（PICU）。
160名年龄≤21岁的严重脓毒症患者。
无。
我们使用多变量Cox回归和逻辑回归检验了从脓毒症确诊至开始使用抗菌药物治疗每延迟一小时与1年死亡率之间的关联。总体1年死亡率为24%（39例患者），其中46%在首次入住PICU出院后死亡。从脓毒症确诊至使用抗菌药物治疗的中位时间为137分钟（四分位间距65 - 287分钟）。在对疾病严重程度和合并症进行校正后，长达3小时的每小时延迟与1年死亡率无关。然而，与在脓毒症确诊后1至3小时内使用抗菌药物的患者相比，在≤1小时（调整后比值比3.8，95%置信区间1.2, 11.7）或>3小时（调整后比值比3.5，95%置信区间1.3, 9.8）使用抗菌药物的患者1年死亡率明显增加。对于首次入住PICU存活的患者亚组，≤1小时使用抗菌药物治疗也与1年死亡率增加相关（调整后比值比5.5，95%置信区间1.1, 27.4），而>3小时使用抗菌药物治疗与1年死亡率无关（调整后比值比2.2，95%置信区间0.5, 11.0）。
在本研究中，小儿严重脓毒症患者长达3小时的每小时延迟使用抗菌药物治疗与1年死亡率无关。脓毒症确诊后≤1小时使用抗菌药物治疗与1年死亡率增加相关这一发现应被视为未来研究的假设来源。
