Vattanavanit Veerapong, Buppodom Theerapat, Khwannimit Bodin
Department of Internal Medicine, Division of Critical Care Medicine.
Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Infect Drug Resist. 2018 Jan 18;11:125-132. doi: 10.2147/IDR.S155099. eCollection 2018.
The timing of intravenous antibiotic administration and lactate measurement is associated with survival of septic shock patients. Septic shock patients were admitted to the medical intensive care unit (MICU) from 2 major sources: hospital ward and emergency department (ED). This study aimed to compare the timing of antibiotic administration and lactate measurement between hospital wards and the ED.
Medical data were collected from adult patients admitted to the MICU with septic shock from January 2015 to December 2016. "Time Zero" was defined as the time of diagnosis of sepsis. The associations between the times and risk-adjusted 28-day mortality were assessed.
In total, 150 septic shock patients were admitted to the MICU. The median time interval (hour [h] interquartile range [IQR]) from time zero to antibiotic administration was higher in patients from the hospital wards compared to those from the ED (4.84 [3.5-8.11] vs 2.04 [1.37-3.54], <0.01), but the lactate level measurement time interval (h [IQR]) from time zero was not different between the hospital wards and the ED (1.6 [0.2-2.7] vs 1.6 [0.9-3.0], =0.85). In multivariate analysis, higher risk-adjusted 28-day mortality was associated with antibiotic monotherapy (odds ratio [OR]: 19.3, 95% confidence interval [CI]: 2.4-153.1, <0.01) and admission during the weekends (OR: 24.4, 95% CI: 2.9-199.8, <0.01).
Antibiotic administration in septic shock patients from the hospital wards took longer, and there was also less appropriate antibiotic prescriptions seen in this group compared with those admitted from the ED. However, neither the timing of antibiotic administration nor lactate measurement was associated with mortality.
静脉注射抗生素的时间和乳酸测量与感染性休克患者的生存率相关。感染性休克患者从两个主要来源被收治入医学重症监护病房（MICU）：医院病房和急诊科（ED）。本研究旨在比较医院病房和急诊科之间抗生素给药时间和乳酸测量时间。
收集了2015年1月至2016年12月因感染性休克入住MICU的成年患者的医疗数据。“零时间”定义为脓毒症诊断时间。评估了这些时间与风险调整后的28天死亡率之间的关联。
共有150例感染性休克患者被收治入MICU。与来自急诊科的患者相比，来自医院病房的患者从零时间到抗生素给药的中位时间间隔（小时[h]四分位间距[IQR]）更高（4.84[3.5 - 8.11]对2.04[1.37 - 3.54]，<0.01），但从零时间开始的乳酸水平测量时间间隔（h[IQR]）在医院病房和急诊科之间没有差异（1.6[0.2 - 2.7]对1.6[0.9 - 3.0]，=0.85）。在多变量分析中，风险调整后的28天死亡率较高与抗生素单药治疗（比值比[OR]：19.3，95%置信区间[CI]：2.4 - 153.1，<0.01）和周末入院（OR：24.4，95%CI：2.9 - 199.8，<0.01）相关。
来自医院病房的感染性休克患者抗生素给药时间更长，与从急诊科入院的患者相比，该组中抗生素处方也不太恰当。然而，抗生素给药时间和乳酸测量时间均与死亡率无关。
