Varney Joseph, Motawea Karam R, Kandil Omneya A, Hashim Hashim T, Murry Kimberly, Shah Jaffer, Shaheen Ahmed, Akwari Joy, Awad Ahmed K, Rivera Amanda, Mostafa Mostafa R, Swed Sarya, Awad Dina M
School of Medicine American University of the Caribbean Cupecoy Sint Maarten.
Faculty of Medicine Alexandria University Alexandria Egypt.
Health Sci Rep. 2022 Apr 1;5(3):e582. doi: 10.1002/hsr2.582. eCollection 2022 Apr.
Some studies have suggested that earlier initiation of antibiotics has shown positive outcomes in sepsis patients. We aimed to do a systematic review and meta-analysis to evaluate the effect of prehospital administration of antibiotics on 28 days mortality and length of stay in hospital and intensive care unit for sepsis patients.
We formulated a search strategy and used it on search databases PubMed, Scopus, Web of Science, and Embase. We then screened the records for eligibility and included controlled studies, either clinical trials or cohort studies reporting prehospital antibiotic administration for sepsis patients. We excluded duplicates, books, conferences' abstracts, case reports, editorials, letters, author responses, not English studies, and studies with nonavailable full text. Animal and lab studies were also excluded.
The total number of studies identified is 1811, 19 were eligible for systematic review and 4 for meta-analysis (three cohort and one clinical trial). The total number of sepsis patients in the four included studies in the 28 days mortality outcome was 3523 (1779 took prehospital antibiotics and 1744 did not take prehospital antibiotics). Of 1779 who took the antibiotics, 190 died, and of 1744 who did not take antibiotics, 292 died (95% confidence interval 0.68-0.97, = 0.02).
This meta-analysis reveals that receiving prehospital antibiotics can significantly lower mortality in sepsis patients compared to patients who do not receive prehospital antibiotics. However, more clinical trials and multicenter prospective studies with high sample sizes are needed to get strong evidence supporting our findings.
一些研究表明，更早开始使用抗生素对脓毒症患者有积极效果。我们旨在进行一项系统评价和荟萃分析，以评估院前使用抗生素对脓毒症患者28天死亡率以及住院和重症监护病房住院时间的影响。
我们制定了检索策略，并将其应用于PubMed、Scopus、Web of Science和Embase等检索数据库。然后我们筛选记录以确定其是否符合条件，并纳入对照研究，即报告脓毒症患者院前使用抗生素的临床试验或队列研究。我们排除了重复项、书籍、会议摘要、病例报告、社论、信件、作者回复、非英文研究以及无法获取全文的研究。动物和实验室研究也被排除。
识别出的研究总数为1811项，19项符合系统评价的条件，4项符合荟萃分析的条件（三项队列研究和一项临床试验）。在28天死亡率结局的四项纳入研究中，脓毒症患者总数为3523例（1779例接受了院前抗生素治疗，1744例未接受院前抗生素治疗）。在接受抗生素治疗的1779例患者中，190例死亡，在未接受抗生素治疗的1744例患者中，292例死亡（95%置信区间0.68 - 0.97，P = 0.02）。
这项荟萃分析表明，与未接受院前抗生素治疗的患者相比，接受院前抗生素治疗可显著降低脓毒症患者的死亡率。然而，需要更多高样本量的临床试验和多中心前瞻性研究来获得有力证据支持我们的发现。
