Ludikhuize Jeroen, Marshall David, Devchand Misha, Walker Steven, Talman Andrew, Taylor Carmel, McIntyre Tammie, Trubiano Jason, Jones Daryl
Austin Health, Department of Intensive Care Medicine in Heidelberg, Australia.
HagaZiekenhuis, Department of Intensive Care Medicine in the Hague, the Netherlands.
Crit Care Resusc. 2023 Aug 9;25(3):136-139. doi: 10.1016/j.ccrj.2023.06.004. eCollection 2023 Sep.
To introduce a management guideline for sepsis-related MET calls to increase lactate and blood culture acquisition, as well as prescription of appropriate antibiotics.
Prospective before (Jun-Aug 2018) and after (Oct-Dec 2018) study was designed.
A public university linked hospital in Melbourne, Australia.
Adult patients with MET calls related to sepsis/infection were included.
The primary outcome measure was the proportion of MET calls during which both a blood culture and lactate level were ordered. Secondary outcomes included the frequency with which new antimicrobials were commenced by the MET, and the presence and class of administered antimicrobials.
There were 985 and 955 MET calls in the baseline and after periods, respectively. Patient features, MET triggers, limitations of treatment and disposition after the MET call were similar in both groups. Compliance with the acquisition of lactates (p = 0.101), respectively. There was a slight reduction in compliance with lactate acquisition in the after period (97% vs 99%; p = 0.06). In contrast, there was a significant increase in acquisition of blood cultures in the after period (69% vs 78%; p = 0.035).
Introducing a sepsis management guideline and enhanced linkage with an AMS program increased blood culture acquisition and decreased broad spectrum antimicrobial use but didn't change in-hospital mortality.
引入一项针对脓毒症相关重症监护病房（MET）呼叫的管理指南，以增加乳酸检测和血培养的采集，以及适当抗生素的处方。
设计了前瞻性的干预前（2018年6月至8月）和干预后（2018年10月至12月）研究。
澳大利亚墨尔本一所与公立大学相关的医院。
纳入与脓毒症/感染相关的MET呼叫的成年患者。
主要观察指标是同时开具血培养和乳酸水平检测医嘱的MET呼叫比例。次要观察指标包括MET开始使用新抗菌药物的频率，以及所使用抗菌药物的种类。
基线期和干预后期分别有985次和955次MET呼叫。两组患者的特征、MET触发因素、治疗局限性以及MET呼叫后的处置情况相似。乳酸检测的依从性分别为（p = 0.101）。干预后期乳酸检测的依从性略有下降（97%对99%；p = 0.06）。相比之下，干预后期血培养的采集有显著增加（69%对78%；p = 0.035）。
引入脓毒症管理指南并加强与抗菌药物管理（AMS）项目的联系，增加了血培养的采集，减少了广谱抗菌药物的使用，但未改变院内死亡率。
