Minderhoud T C, Spruyt C, Huisman S, Oskam E, Schuit S C E, Levin M D
Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
Neth J Med. 2017 Jun;75(5):196-203.
To study the presence of bacterial disease and antibiotic use in patients in the emergency department (ED) included in the local sepsis protocol.
An observational retrospective cohort study. Adults aged > 18 years, presenting to the ED of a large teaching hospital, from 1 January to 1 June 2011, with more than two SIRS criteria and a clinical suspicion of sepsis were included.
Bacterial disease was suspected or confirmed in only 71% of all the patients with suspected sepsis (2008 definition) and consequently treated with antibiotics. Most of these patients (58%) suffered from systemic inflammatory response syndrome (SIRS) without signs of organ dysfunction, hypotension or hypoperfusion. Despite absence of bacterial disease in 29% of the patients after rigorous diagnostics, median antibiotic treatment in this group was still seven days (IQR 4-10).
Standard sepsis detection using SIRS criteria and clinical suspicion identified patients with suspected or confirmed bacterial disease in 71% of the cases. A significant proportion of patients were exposed to prolonged antibiotic use without proof of bacterial disease. This study illustrates the difficulties in correctly identifying bacterial disease and sepsis, and shows that overuse of antibiotics may be the consequence.
研究纳入当地脓毒症诊疗方案的急诊科（ED）患者的细菌性疾病情况及抗生素使用情况。
一项观察性回顾性队列研究。纳入2011年1月1日至6月1日期间前往一家大型教学医院急诊科就诊、年龄大于18岁、符合两项以上全身炎症反应综合征（SIRS）标准且临床怀疑脓毒症的成年人。
在所有疑似脓毒症（2008年定义）患者中，仅71%的患者疑似或确诊细菌性疾病并因此接受抗生素治疗。这些患者中的大多数（58%）患有全身炎症反应综合征（SIRS），但无器官功能障碍、低血压或灌注不足的体征。尽管经过严格诊断，29%的患者不存在细菌性疾病，但该组患者的抗生素治疗中位时间仍为7天（四分位间距4 - 10天）。
使用SIRS标准和临床怀疑进行标准脓毒症检测，在71%的病例中识别出疑似或确诊细菌性疾病的患者。相当一部分患者在未证实存在细菌性疾病的情况下接受了长时间的抗生素治疗。本研究说明了正确识别细菌性疾病和脓毒症存在困难，并表明可能会导致抗生素过度使用。
