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院前对脓毒症的怀疑能否缩短急诊科抗生素给药时间?一项在某大学医院开展的回顾性研究。

Does Prehospital Suspicion of Sepsis Shorten Time to Administration of Antibiotics in the Emergency Department? A Retrospective Study in One University Hospital.

作者信息

Bollinger Matthias, Frère Nadja, Shapeton Alexander Daniel, Schary Weronika, Kohl Matthias, Kill Clemens, Riße Joachim

机构信息

Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Schwarzwald-Baar Hospital, Klinikstrasse 11, 78052 Villingen-Schwenningen, Germany.

Department of Anesthesiology I, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany.

出版信息

J Clin Med. 2023 Aug 30;12(17):5639. doi: 10.3390/jcm12175639.

Abstract

Early treatment is the mainstay of sepsis therapy. We suspected that early recognition of sepsis by prehospital healthcare providers may shorten the time for antibiotic administration in the emergency department. We retrospectively evaluated all patients above 18 years of age who were diagnosed with sepsis or severe infection in our emergency department between 2018 and 2020. We recorded the suspected diagnosis at the time of presentation, the type of referring healthcare provider, and the time until initiation of antibiotic treatment. Differences between groups were calculated using the Kruskal-Wallis rank sum test. Of the 277 patients who were diagnosed with severe infection or sepsis in the emergency department, an infection was suspected in 124 (44.8%) patients, and sepsis was suspected in 31 (11.2%) patients by referring healthcare providers. Time to initiation of antibiotic treatment was shorter in patients where sepsis or infection had been suspected prior to arrival for both patients with severe infections ( = 0.022) and sepsis ( = 0.004). Given the well-described outcome benefits of early sepsis therapy, recognition of sepsis needs to be improved. Appropriate scores should be used as part of routine patient assessment to reduce the time to antibiotic administration and improve patient outcomes.

摘要

早期治疗是脓毒症治疗的关键。我们怀疑,院前医疗服务提供者对脓毒症的早期识别可能会缩短急诊科抗生素给药时间。我们回顾性评估了2018年至2020年间在我院急诊科被诊断为脓毒症或严重感染的所有18岁以上患者。我们记录了就诊时的疑似诊断、转诊医疗服务提供者的类型以及开始抗生素治疗的时间。使用Kruskal-Wallis秩和检验计算组间差异。在急诊科被诊断为严重感染或脓毒症的277例患者中,转诊医疗服务提供者怀疑124例(44.8%)患者感染,怀疑31例(11.2%)患者为脓毒症。对于严重感染患者(P = 0.022)和脓毒症患者(P = 0.004),到达前怀疑有脓毒症或感染的患者开始抗生素治疗的时间较短。鉴于早期脓毒症治疗已明确的预后益处,脓毒症的识别需要改进。应使用适当的评分作为常规患者评估的一部分,以减少抗生素给药时间并改善患者预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d24c/10488377/f76a736babc6/jcm-12-05639-g001.jpg

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