Pedroso José Victor de Miranda, Motter Fabiane Raquel, Koba Sonia Tiemi, Camargo Mayara Costa, de Toledo Maria Inês, Del Fiol Fernando de Sá, Silva Marcus Tolentino, Lopes Luciane Cruz
Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, UNISO, São Paulo, Brazil.
Posgraduate Program in Tropical Medicine, University of Brasilia (UnB), Brasília, Brazil.
Front Pharmacol. 2021 Feb 12;11:576849. doi: 10.3389/fphar.2020.576849. eCollection 2020.
The aim of the present study was to determine whether de-escalation guided by blood cultures for patients with a diagnosis of sepsis, severe sepsis or septic shock reduces mortality, and antimicrobial drug resistance (ADR). A prospective, single-center, cohort study was conducted with adults admitted to the ICU with a diagnosis of sepsis, severe sepsis, or septic shock at a public hospital in Sorocaba, State of São Paulo, Brazil, from January 2013 to December 2013. We excluded patients who had negative blood cultures. Patients who had replaced the initial empirical broad-spectrum antibiotic therapy (EAT) by the antibiotic therapy guided by blood cultures were compared with those who continued receiving EAT. The outcome included mortality and antimicrobial drug resistance. We used the Cox regression (proportional hazards regression) and the Poisson regression to analyze the association between antibiotic therapy guided by blood cultures (ATGBC) and outcomes. The statistical adjustment in all models included the following variables: sex, age, APACHE II (Acute Physiology And Chronic Health Evaluation II) score and SOFA (Sequential Organ Failure Assessment) score. Among the 686 patients who were admitted to the intensive care unit, 91 were included in this study. The mean age of the patients was 52.7 years (standard deviation = 18.5 years) and 70.3% were male. EAT was replaced by ATGBC in 33 patients (36.3%) while 58 patients (63.7%) continued receiving EAT. Overall hospital mortality decreased from 56.9% in patients who received EAT to 48.5% in patients who received ATGBC [Hazard ratio- HR 0.44 (95% CI 0.24-0.82), = 0.009]. There was no association between ATGBC and ADR [HR 0.90 (95% CI 0.78 - 1.03) = 0.15]. Although the early and appropriate empirical EAT is undoubtedly an important factor prognostic, ATGBC can reduce the mortality in these patients.
本研究的目的是确定对于诊断为脓毒症、严重脓毒症或脓毒性休克的患者，依据血培养结果进行降阶梯治疗是否能降低死亡率及抗菌药物耐药性（ADR）。2013年1月至2013年12月，在巴西圣保罗州索罗卡巴市的一家公立医院，对诊断为脓毒症、严重脓毒症或脓毒性休克并入住重症监护病房（ICU）的成年患者进行了一项前瞻性、单中心队列研究。我们排除了血培养结果为阴性的患者。将依据血培养结果指导抗生素治疗替代初始经验性广谱抗生素治疗（EAT）的患者与继续接受EAT的患者进行比较。观察指标包括死亡率和抗菌药物耐药性。我们使用Cox回归（比例风险回归）和泊松回归分析血培养结果指导的抗生素治疗（ATGBC）与观察指标之间的关联。所有模型中的统计调整均纳入以下变量：性别、年龄、急性生理与慢性健康状况评分系统II（APACHE II）评分和序贯器官衰竭评估（SOFA）评分。在686名入住重症监护病房的患者中，91名被纳入本研究。患者的平均年龄为52.7岁（标准差 = 18.5岁），男性占70.3%。33名患者（36.3%）的EAT被ATGBC替代，而58名患者（63.7%）继续接受EAT。总体医院死亡率从接受EAT的患者中的56.9%降至接受ATGBC的患者中的48.5% [风险比 - HR 0.44（95%置信区间0.24 - 0.82），P = 0.009]。ATGBC与ADR之间无关联 [HR 0.90（95%置信区间0.78 - ），P = 0.15]。尽管早期且恰当的经验性EAT无疑是一个重要的预后因素，但ATGBC可降低这些患者的死亡率。
