Lee Ching-Chi, Yang Chao-Yung, Su Bo-An, Hsieh Chih-Chia, Hong Ming-Yuan, Lee Chung-Hsun, Ko Wen-Chien
Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
J Clin Med. 2020 Aug 12;9(8):2617. doi: 10.3390/jcm9082617.
Bacteremia is linked to substantial morbidity and medical costs. However, the association between the timing of achieving hemodynamic stability and clinical outcomes remains undetermined. Of the multicenter cohort consisted of 888 adults with community-onset bacteremia initially complicated with severe sepsis and septic shock in the emergency department (ED), a positive linear-by-linear association ( = 0.839, < 0.001) of the time-to-appropriate antibiotic (TtAa) and the hypotension period after appropriate antimicrobial therapy (AAT) was exhibited, and a positive trend of the hypotension period after AAT administration in the 15-day ( = 0.957, = 0.003) or 30-day crude ( = 0.975, = 0.001) mortality rate was evidenced. Moreover, for every hour delay of the TtAa, 30-day survival dropped an average of 0.8% (adjusted odds ratio [AOR], 1.008; < 0.001); and each additional hour of the hypotension period following AAT initiation notably resulted in with an average 1.1% increase (AOR, 1.011; < 0.001) in the 30-day crude mortality rate, after adjusting all independent determinants of 30-day mortality recognized by the multivariate regression model. Conclusively, for bacteremia patients initially experiencing severe sepsis and septic shock, prompt AAT administration might shorten the hypotension period to achieve favourable prognoses.
菌血症与严重的发病率和医疗费用相关。然而，实现血流动力学稳定的时机与临床结局之间的关联仍未确定。在一个多中心队列中，有888名社区获得性菌血症的成年人，他们最初在急诊科因严重脓毒症和感染性休克而病情复杂，结果显示，合适抗生素使用时间（TtAa）与合适抗菌治疗（AAT）后的低血压期呈正线性关联（ = 0.839， < 0.001），并且在15天（ = 0.957， = 0.003）或30天粗死亡率（ = 0.975， = 0.001）方面，AAT给药后的低血压期呈上升趋势。此外，TtAa每延迟一小时，30天生存率平均下降0.8%（调整优势比[AOR]，1.008； < 0.001）；在调整多变量回归模型所识别的30天死亡率的所有独立决定因素后，AAT开始后低血压期每增加一小时，30天粗死亡率平均显著增加1.1%（AOR，1.011； < 0.001）。总之，对于最初经历严重脓毒症和感染性休克的菌血症患者，及时给予AAT可能会缩短低血压期以获得良好预后。
