Usher Michael G, Tourani Roshan, Webber Ben, Tignanelli Christopher J, Ma Sisi, Pruinelli Lisiane, Rhodes Michael, Sahni Nishant, Olson Andrew P J, Melton Genevieve B, Simon Gyorgy
Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
Institute for Health Informatics, University of Minnesota Medical School, Minneapolis, MN.
Crit Care Med. 2022 May 1;50(5):799-809. doi: 10.1097/CCM.0000000000005429. Epub 2022 Jan 3.
Sepsis remains a leading and preventable cause of hospital utilization and mortality in the United States. Despite updated guidelines, the optimal definition of sepsis as well as optimal timing of bundled treatment remain uncertain. Identifying patients with infection who benefit from early treatment is a necessary step for tailored interventions. In this study, we aimed to illustrate clinical predictors of time-to-antibiotics among patients with severe bacterial infection and model the effect of delay on risk-adjusted outcomes across different sepsis definitions.
A multicenter retrospective observational study.
A seven-hospital network including academic tertiary care center.
Eighteen thousand three hundred fifteen patients admitted with severe bacterial illness with or without sepsis by either acute organ dysfunction (AOD) or systemic inflammatory response syndrome positivity.
The primary exposure was time to antibiotics. We identified patient predictors of time-to-antibiotics including demographics, chronic diagnoses, vitals, and laboratory results and determined the impact of delay on a composite of inhospital death or length of stay over 10 days. Distribution of time-to-antibiotics was similar across patients with and without sepsis. For all patients, a J-curve relationship between time-to-antibiotics and outcomes was observed, primarily driven by length of stay among patients without AOD. Patient characteristics provided good to excellent prediction of time-to-antibiotics irrespective of the presence of sepsis. Reduced time-to-antibiotics was associated with improved outcomes for all time points beyond 2.5 hours from presentation across sepsis definitions.
Antibiotic timing is a function of patient factors regardless of sepsis criteria. Similarly, we show that early administration of antibiotics is associated with improved outcomes in all patients with severe bacterial illness. Our findings suggest identifying infection is a rate-limiting and actionable step that can improve outcomes in septic and nonseptic patients.
在美国，脓毒症仍然是导致住院治疗和死亡的主要且可预防的原因。尽管有了更新的指南，但脓毒症的最佳定义以及集束治疗的最佳时机仍不明确。识别能从早期治疗中获益的感染患者是进行针对性干预的必要步骤。在本研究中，我们旨在阐明重症细菌感染患者使用抗生素时间的临床预测因素，并模拟延迟使用抗生素对不同脓毒症定义下风险调整后结局的影响。
一项多中心回顾性观察研究。
一个包括学术性三级医疗中心的七家医院网络。
18315例因急性器官功能障碍（AOD）或全身炎症反应综合征阳性而患有或未患有脓毒症的重症细菌性疾病患者。
主要暴露因素是使用抗生素的时间。我们确定了使用抗生素时间的患者预测因素，包括人口统计学特征、慢性诊断、生命体征和实验室检查结果，并确定了延迟使用抗生素对住院死亡或住院时间超过10天这一综合指标的影响。有脓毒症和无脓毒症患者的抗生素使用时间分布相似。对于所有患者，观察到抗生素使用时间与结局之间呈J曲线关系，主要由无AOD患者的住院时间驱动。无论是否存在脓毒症，患者特征对使用抗生素时间都有良好至极佳的预测作用。在所有脓毒症定义下，从就诊起超过2.5小时后的所有时间点，缩短抗生素使用时间均与改善结局相关。
无论脓毒症标准如何，抗生素使用时间取决于患者因素。同样，我们表明早期使用抗生素与所有重症细菌性疾病患者的结局改善相关。我们的研究结果表明，识别感染是一个限速且可采取行动的步骤，可改善脓毒症和非脓毒症患者的结局。
