Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, Switzerland; Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland.
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland.
J Infect. 2021 May;82(5):125-134. doi: 10.1016/j.jinf.2021.03.003. Epub 2021 Mar 17.
To review the impact of the timeliness of antibiotic therapy on the outcome of patients with sepsis or septic shock.
We searched MEDLINE, EMBASE, the Cochrane Library, Web of Science, Open-SIGLE databases, ClinicalTrials.gov and the metaRegister of Controlled Trials on July 27, 2020 for relevant studies on the timing of antibiotic therapy in adult patients with sepsis or septic shock. The primary outcome measure was all-cause crude or adjusted mortality at reported time points.
We included 35 sepsis studies involving 154,330 patients. Nineteen studies (54%) provided information on the appropriateness of antibiotic therapy in 20,062 patients of whom 16,652 patients (83%) received appropriate antibiotics. Twenty-four studies (68.6%) reported an association between time-to-antibiotics and mortality. Time thresholds associated with patient's outcome varied considerably between studies consisting of a wide range of time cutoffs (1 h, 125 min, 3 h or 6 h) in 14 studies, hourly delays (derived from the analyses of time intervals ranging from to 1 to 24 h) in 8 studies or time-to-antibiotic in 2 studies. Analyses of subsets of studies that focused on patients with septic shock (11 studies, 12,756 patients) or with sepsis (6 studies, 24,281 patients) yielded similar results.
While two-thirds of sepsis studies reported an association between early administration of antibiotic therapy and patient outcome, the time-to-antibitiocs metrics varied significantly across studies and no robust time thresholds emerged.
回顾抗生素治疗时机对脓毒症或脓毒性休克患者结局的影响。
我们于 2020 年 7 月 27 日检索了 MEDLINE、EMBASE、Cochrane 图书馆、Web of Science、Open-SIGLE 数据库、ClinicalTrials.gov 和对照试验注册库，以获取有关成人脓毒症或脓毒性休克患者抗生素治疗时机的相关研究。主要结局测量指标为报告时间点的全因粗死亡率或校正死亡率。
我们纳入了 35 项脓毒症研究，共涉及 154330 例患者。19 项研究（54%）提供了 20062 例患者抗生素治疗是否恰当的信息，其中 16652 例（83%）患者接受了恰当的抗生素治疗。24 项研究（68.6%）报告了抗生素使用时间与死亡率之间的关系。在 14 项研究中，时间阈值与患者结局之间的关联差异较大，包括各种时间截止值（1 小时、125 分钟、3 小时或 6 小时）；8 项研究中采用了每小时延迟（来自分析时间间隔从 1 小时到 24 小时）；2 项研究中则采用了抗生素使用时间。对关注脓毒性休克患者（11 项研究，12756 例患者）或脓毒症患者（6 项研究，24281 例患者）的研究亚组进行分析，得到了相似的结果。
尽管三分之二的脓毒症研究报告了早期使用抗生素治疗与患者结局之间的关联，但抗生素使用时间的衡量指标在研究之间差异显著，没有出现稳健的时间阈值。
