Bae Hong-Jun, Kim June-Sung, Kim Muyeol, Kim Youn-Jung, Kim Won Young
Asan Medical Center, Department of Emergency Medicine, College of Medicine, University of Ulsan, Seoul 05505, Korea.
Antibiotics (Basel). 2021 Jun 8;10(6):683. doi: 10.3390/antibiotics10060683.
To evaluate the prognostic value of the time-to-positivity in patients with culture-positive septic shock.
Retrospective study using a prospective data registry was performed at the emergency department of a tertiary hospital. Consecutive adult patients with septic shock (N = 2499) were enrolled between 2014 and 2018. Bacteremia was defined using blood cultures, and viral and fungal pathogens were excluded. The primary outcome was the 28-day mortality.
In 803 (46.7%) septic shock patients with bacteremia, median TTP was 10.1 h. The most prevalent isolated bacterial pathogens were (40.8%) and (23.4%). Although the TTP correlated with a higher sequential organ failure assessment score (Spearman's rho = -0.12, < 0.01), it showed no significant difference between the 28-day survivors and non-survivors (10.2 vs. 9.4 days, = 0.35). In subgroup analysis of the and bacteremia cases, a shorter TTP showed prognostic value for predicting the 28-day mortality. The optimal TTP cut-off for and was 10 h and 8 h, respectively.
The prognostic value of the TTP in septic shock patients receiving bundle therapy may be limited and its clinical interpretation should only be made on a pathogen-specific basis.
评估培养阳性的感染性休克患者阳性时间的预后价值。
在一家三级医院的急诊科进行了一项使用前瞻性数据登记的回顾性研究。纳入了2014年至2018年间连续的成年感染性休克患者（N = 2499）。通过血培养定义菌血症，并排除病毒和真菌病原体。主要结局是28天死亡率。
在803例（46.7%）菌血症感染性休克患者中，中位阳性时间为10.1小时。最常见的分离细菌病原体是（40.8%）和（23.4%）。虽然阳性时间与较高的序贯器官衰竭评估评分相关（Spearman相关系数=-0.12，<0.01），但在28天存活者和非存活者之间无显著差异（10.2天对9.4天，=0.35）。在和菌血症病例的亚组分析中，较短的阳性时间对预测28天死亡率具有预后价值。和菌血症的最佳阳性时间截断值分别为10小时和8小时。
在接受集束治疗的感染性休克患者中，阳性时间的预后价值可能有限，其临床解读应仅基于病原体特异性进行。
