Alsadoon Alaa, Alhamwah Moudi, Alomar Bassam, Alsubaiel Sara, Almutairi Adel F, Vishwakarma Ramesh K, Alharthy Nesrin, Kazzaz Yasser M
Department of Pediatrics, Ministry of National Guards-Health Affairs, Riyadh, Saudi Arabia.
Pediatrics Emergency Department, Ministry of National Guards-Health Affairs, Riyadh, Saudi Arabia.
Front Pediatr. 2020 Sep 9;8:566. doi: 10.3389/fped.2020.00566. eCollection 2020.
To investigate the association between antibiotics administration timing with morbidity and mortality in children with severe sepsis and septic shock, presenting to a tertiary care center in a developing country. This is a retrospective study of children aged 14 years or younger diagnosed with severe sepsis or septic shock at a free-standing tertiary children's hospital in Saudi Arabia between April 2015 and February 2018. We investigated the association between antibiotic administration timing and pediatric intensive care unit (PICU) mortality, PICU length of stay (LOS), hospital LOS, and ventilation-free days after adjusting for confounders. Among the 189 admissions, 77 patients were admitted with septic shock and 112 with severe sepsis. Overall, the mortality rate was 16.9%. The overall median time from sepsis recognition to antibiotic administration was 105 min (IQR: 65-185.5 min); for septic shock patients, it was 85 min (IQR: 55-148 min), and for severe sepsis, 130 min (IQR: 75.5-199 min). Delayed antibiotic administration (> 3 h) was associated with 3.85 times higher PICU mortality (95% confidence intervals 1.032-14.374) in children with septic shock than in children who receive antibiotics within 3 h, after controlling for severity of illness, age, comorbidities, and volume resuscitation. However, delayed antibiotics administration was not significantly associated with higher PICU mortality in children diagnosed with severe sepsis. Delayed antibiotics administration in children with septic shock admitted to a free-standing children's hospital in a developing country was associated with PICU mortality.
为研究在一家发展中国家的三级医疗中心就诊的重症脓毒症和脓毒性休克患儿中，抗生素给药时机与发病率和死亡率之间的关联。这是一项对2015年4月至2018年2月期间在沙特阿拉伯一家独立的三级儿童医院被诊断为重症脓毒症或脓毒性休克的14岁及以下儿童进行的回顾性研究。在调整混杂因素后，我们研究了抗生素给药时机与儿科重症监护病房（PICU）死亡率、PICU住院时间（LOS）、医院住院时间以及无通气天数之间的关联。在189例入院病例中，77例患者因脓毒性休克入院，112例因重症脓毒症入院。总体而言，死亡率为16.9%。从脓毒症识别到抗生素给药的总体中位时间为105分钟（四分位间距：65 - 185.5分钟）；脓毒性休克患者为85分钟（四分位间距：55 - 148分钟），重症脓毒症患者为130分钟（四分位间距：75.5 - 199分钟）。在控制了疾病严重程度、年龄、合并症和液体复苏情况后，脓毒性休克患儿延迟抗生素给药（> 3小时）与在3小时内接受抗生素治疗的患儿相比，PICU死亡率高3.85倍（95%置信区间1.032 - 14.374）。然而，延迟抗生素给药与诊断为重症脓毒症的患儿较高的PICU死亡率无显著关联。在一家发展中国家独立儿童医院就诊的脓毒性休克患儿中，延迟抗生素给药与PICU死亡率相关。
