National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, University of Melbourne, Level 5, 792 Elizabeth St., Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine-RMH, Royal Parade, Melbourne, VIC, Australia; Pharmacy Department, Ballarat Health Services, Drummond St., Ballarat, VIC, Australia.
Pharmacy Department, Ballarat Health Services, Drummond St., Ballarat, VIC, Australia.
J Glob Antimicrob Resist. 2021 Jun;25:367-369. doi: 10.1016/j.jgar.2021.04.007. Epub 2021 May 12.
There have been efforts to promote timely antimicrobial administration for patients with sepsis, but the importance for other infections is uncertain. This study analysed whether time to first antimicrobial dose (TFAD) in patients with lower limb cellulitis influenced outcome measures such as acute length of stay (LOS) in hospital and 30-day hospital readmission rates for cellulitis.
Medical records of patients admitted with lower limb cellulitis or erysipelas over a 15-month period (1 May 2019 to 30 November 2019 and 1 March 2020 to 31 October 2020) were reviewed. Patients requiring intensive care unit (ICU) admission were excluded. The TFAD was the difference (in minutes) between the emergency department triage time and the time that the antimicrobial was first recorded as administered. Analysis included log-transformed linear regression (for LOS) and logistic regression (for 30-day readmission with cellulitis), controlling for confounders where possible.
The study included 282 patients with lower limb cellulitis. The median TFAD was 177 min (interquartile range, 98-290 min). Linear regression suggested a weak association between TFAD and LOS (P = 0.05; adjusted R = 0.01), which was non-significant after adjusting for confounders (P = 0.18). There were too few patients readmitted within 30 days with cellulitis for meaningful analysis.
After controlling for confounders, no association between increased TFAD and increased acute LOS was identified for patients with lower limb cellulitis who did not require ICU admission (i.e. without septic shock). Conclusions could not be made for 30-day readmission rates for cellulitis.
人们一直在努力促进脓毒症患者及时使用抗菌药物，但其他感染的重要性尚不确定。本研究分析了下肢蜂窝织炎患者首次抗菌药物剂量（TFAD）的时间是否会影响急性住院时间（LOS）和 30 天内蜂窝织炎再入院率等结果测量指标。
回顾了在 15 个月期间（2019 年 5 月 1 日至 11 月 30 日和 2020 年 3 月 1 日至 10 月 31 日）因下肢蜂窝织炎或丹毒入院的患者的病历。排除需要入住重症监护病房（ICU）的患者。TFAD 为急诊科分诊时间与首次记录抗菌药物给药时间之间的差异（以分钟为单位）。分析包括对数转换线性回归（用于 LOS）和逻辑回归（用于 30 天内再入院蜂窝织炎），在可能的情况下控制混杂因素。
该研究纳入了 282 例下肢蜂窝织炎患者。中位 TFAD 为 177 分钟（四分位间距，98-290 分钟）。线性回归表明 TFAD 与 LOS 之间存在弱关联（P=0.05；调整后的 R=0.01），但在调整混杂因素后无统计学意义（P=0.18）。在 30 天内因蜂窝织炎再次入院的患者人数太少，无法进行有意义的分析。
在控制混杂因素后，对于无需入住 ICU（即无脓毒性休克）的下肢蜂窝织炎患者，增加 TFAD 与急性 LOS 增加之间没有关联。对于 30 天内蜂窝织炎的再入院率，无法得出结论。
