Harpenau Tara L, Bhatti Samiyah N, Hoffman Brian M, Kirsch William B
Department of Pharmacy, ProMedica Toledo Hospital and Russell J. Ebeid Children's Hospital, Toledo, OH 43606, USA.
Department of Pharmacy, ProMedica Toledo Hospital and Russell J. Ebeid Children's Hospital, Toledo, OH 43606, USA.
Am J Emerg Med. 2022 May;55:32-37. doi: 10.1016/j.ajem.2022.02.028. Epub 2022 Feb 24.
For patients with sepsis and septic shock, the initial administration of antibiotics should occur as soon as possible, preferably within one hour of sepsis recognition. While clinicians are focused on providing first-doses of antibiotics quickly upon presentation, re-dosing issues may arise in patients who have an extended emergency department (ED) length of stay (LOS). Limited studies have been conducted that assess the impact of re-dosing delays. The purpose of this study was to assess the association of an extended ED LOS ≥ 6 h with antibiotic re-dosing delays in patients with sepsis and examine outcomes.
A retrospective cohort study comparing patients with sepsis with an ED LOS of <6 h to those with an ED LOS of ≥6 h was performed between March 2018 and February 2020. Patients ≥18 years old admitted from the ED with sepsis or septic shock were included. The primary outcome was incidence of delay to the second dose of antibiotics in those with an extended ED LOS compared to those without. Secondary outcomes included intensive care unit (ICU) LOS, hospital LOS, rate of transfer from non-ICU to ICU settings, incidence and duration of mechanical ventilation, and in-hospital mortality. An exploratory analysis compared outcomes in patients with and without a re-dosing delay.
Of the 128 patients included, 99 patients had an ED LOS < 6 h and 29 patients had an ED LOS ≥ 6 h. A delay to second dose of antibiotics occurred in 30 (30.3%) patients in the ED LOS < 6 h group versus 7 (24.1%) patients in the ED LOS ≥ 6 h group (p = 0.52). Secondary outcomes did not significantly differ between the two groups. In-hospital mortality was numerically higher in those with a re-dosing delay when compared to those without in the exploratory analysis (18.9% vs. 8.8%, p = 0.11).
There was no statistically significant difference in the incidence of delays to the second dose of antibiotics among patients with sepsis with an ED LOS of <6 h versus those with an ED LOS of ≥6 h. The high incidence of antibiotic re-dosing delays in both groups, indicates an overall need for improved transitions of care in the ED sepsis population.
对于脓毒症和脓毒性休克患者，应尽快开始使用抗生素，最好在识别脓毒症后一小时内使用。虽然临床医生专注于在患者就诊后迅速给予首剂抗生素，但在急诊科（ED）住院时间（LOS）延长的患者中可能会出现再次给药的问题。评估再次给药延迟影响的研究有限。本研究的目的是评估脓毒症患者急诊科住院时间延长≥6小时与抗生素再次给药延迟之间的关联并检查预后情况。
在2018年3月至2020年2月期间进行了一项回顾性队列研究，比较急诊科住院时间<6小时的脓毒症患者与住院时间≥6小时的脓毒症患者。纳入年龄≥18岁因脓毒症或脓毒性休克从急诊科入院的患者。主要结局是急诊科住院时间延长的患者与未延长的患者相比，延迟给予第二剂抗生素的发生率。次要结局包括重症监护病房（ICU）住院时间、医院住院时间、从非ICU转至ICU的比例、机械通气的发生率和持续时间以及院内死亡率。一项探索性分析比较了有和没有再次给药延迟的患者的预后情况。
在纳入的128例患者中，99例患者的急诊科住院时间<6小时，29例患者的急诊科住院时间≥6小时。急诊科住院时间<6小时组中有30例（30.3%）患者延迟给予第二剂抗生素，而急诊科住院时间≥6小时组中有7例（24.1%）患者出现延迟（p = 0.52）。两组的次要结局没有显著差异。在探索性分析中，有再次给药延迟的患者的院内死亡率在数值上高于没有延迟的患者（18.9%对8.8%，p = 0.11）。
急诊科住院时间<6小时的脓毒症患者与住院时间≥6小时的脓毒症患者相比，延迟给予第二剂抗生素的发生率没有统计学上的显著差异。两组抗生素再次给药延迟的发生率都很高，表明急诊科脓毒症患者总体上需要改善护理转接。
