急诊科严重脓毒症和脓毒性休克早期管理的感染病团队。

Infectious Diseases Team for the Early Management of Severe Sepsis and Septic Shock in the Emergency Department.

机构信息

Infectious Diseases Unit, Department of Medical and Surgical Sciences, Hospital S. Orsola-Malpighi, University of Bologna.

Clinical Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia.

出版信息

Clin Infect Dis. 2017 Oct 15;65(8):1253-1259. doi: 10.1093/cid/cix548.

DOI:10.1093/cid/cix548

PMID:28605525

Abstract

BACKGROUND

The impact on patient survival of an infectious disease (ID) team dedicated to the early management of severe sepsis/septic shock (SS/SS) in Emergency Department (ED) has yet to be assessed.

METHODS

A quasiexperimental pre-post study was performed at the general ED of our hospital. During the pre phase (June 2013-July 2014), all consecutive adult patients with SS/SS were managed according to the standard of care, data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team performing a bedside patient evaluation within 1 hour of ED arrival.

RESULTS

Overall, 382 patients were included, 195 in the pre phase and 187 in the post phase. Median age was 82 years (interquartile range, 70-88). The most common infection sources were lung (43%) and urinary tract (17%); in 22% of cases, infection source remained unknown. During the post phase, overall compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P < .001) and from 30% to 79% (P < .001), respectively. Multivariate analysis showed that predictors of all-cause 14-day mortality were quick sepsis-related organ failure assessment ≥2 (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.15-2.45; P = .007), serum lactate ≥2 mmol/L (HR, 2.13; 95% CI, 1.39-3.25; P < .001), and unknown infection source (HR, 2.07; 95% CI, 1.42-3.02; P < .001); being attended during the post phase was a protective factor (HR, 0.64; 95% CI, 0.43-0.94; P = .026).

CONCLUSION

Implementation of an ID team for the early management of SS/SS in the ED improved the adherence to SSC recommendations and patient survival.

摘要

背景

专门致力于急诊部门（ED）严重脓毒症/脓毒性休克（SS/SS）早期管理的传染病（ID）团队对患者生存的影响尚未得到评估。

方法

在我院普通 ED 进行了一项准实验前后研究。在前期（2013 年 6 月至 2014 年 7 月），所有连续的 SS/SS 成年患者均按照标准护理进行管理，前瞻性收集数据。在后期（2014 年 8 月至 2015 年 10 月），与专门的 ID 团队合作，在 ED 到达后 1 小时内对患者进行床边评估。

结果

共纳入 382 例患者，前期 195 例，后期 187 例。中位年龄为 82 岁（四分位间距，70-88 岁）。最常见的感染源是肺部（43%）和尿路（17%）；在 22%的病例中，感染源仍然未知。在后期，整体上遵守拯救脓毒症运动（SSC）捆绑包和初始抗生素治疗的适当性从 4.6%提高到 32%（P <.001）和从 30%提高到 79%（P <.001）。多变量分析显示，14 天全因死亡率的预测因素为快速脓毒症相关器官衰竭评估≥2（危险比[HR]，1.68；95%置信区间[CI]，1.15-2.45；P =.007），血清乳酸≥2 mmol/L（HR，2.13；95%CI，1.39-3.25；P <.001）和未知感染源（HR，2.07；95%CI，1.42-3.02；P <.001）；在后期接受治疗是一个保护因素（HR，0.64；95%CI，0.43-0.94；P =.026）。