Department of Internal Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC.
Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC.
Crit Care Med. 2021 May 1;49(5):741-747. doi: 10.1097/CCM.0000000000004863.
Rapid delivery of antibiotics is a cornerstone of sepsis therapy, although time targets for specific components of antibiotic delivery are unknown. We quantified time intervals comprising the task of antibiotic delivery and evaluated the association between interval delays and hospital mortality among patients treated in the emergency department for suspected sepsis.
Retrospective cohort.
Twelve hospitals in Southeastern United States from 2014 to 2017.
Twenty-four thousand ninety-three encounters among 20,026 adults with suspected sepsis in 12 emergency departments.
We divided antibiotic administration into two intervals: time from emergency department triage to antibiotic order (recognition delay) and time from antibiotic order to infusion (administration delay). We used generalized linear mixed models to evaluate associations between these intervals and hospital mortality. Median time from emergency department triage to antibiotic administration was 3.4 hours (interquartile range, 2.0-6.0 hr), separated into a median recognition delay (time from emergency department triage to antibiotic order) of 2.7 hours(interquartile range, 1.5-4.7 hr) and median administration delay (time from antibiotic order to infusion) of 0.6 hours (0.3-1.2 hr). Adjusting for other risk factors, both recognition delay and administration delay were associated with mortality, but pairwise comparison with a no-delay reference group was not significant for up to 6 hours of recognition delay or up to 1.5 hours of administration delay.
Both recognition delays and administration delays were associated with increased hospital mortality, but only for longer delays. These results suggest that both metrics may be important to measure and improve for patients with suspected sepsis but do not support targets less than 1 hour.
快速给予抗生素是脓毒症治疗的基石，尽管抗生素给药的特定组成部分的时间目标尚不清楚。我们量化了构成抗生素给药任务的时间间隔，并评估了在急诊科接受疑似脓毒症治疗的患者中，这些间隔延迟与医院死亡率之间的关系。
回顾性队列研究。
2014 年至 2017 年美国东南部的 12 家医院。
12 家急诊科 20026 名疑似脓毒症成人中的 24093 例就诊。
我们将抗生素给药分为两个间隔：从急诊科分诊到抗生素医嘱的时间（识别延迟）和从抗生素医嘱到输注的时间（给药延迟）。我们使用广义线性混合模型评估这些间隔与医院死亡率之间的关联。从急诊科分诊到抗生素给药的中位时间为 3.4 小时（四分位距，2.0-6.0 小时），分为中位识别延迟（从急诊科分诊到抗生素医嘱的时间）2.7 小时（四分位距，1.5-4.7 小时）和中位给药延迟（从抗生素医嘱到输注的时间）0.6 小时（0.3-1.2 小时）。在调整其他危险因素后，识别延迟和给药延迟均与死亡率相关，但与无延迟参考组进行的两两比较在长达 6 小时的识别延迟或长达 1.5 小时的给药延迟时无显著意义。
识别延迟和给药延迟均与医院死亡率增加相关，但仅在延迟时间较长时才相关。这些结果表明，对于疑似脓毒症患者，这两个指标都可能需要测量和改进，但支持的目标时间不小于 1 小时。
