Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI.
Department of Internal Medicine, Wake Forest University School of Medicine, Center for Health System Sciences, Atrium Health, Charlotte, NC.
Crit Care Med. 2024 Jul 1;52(7):1002-1006. doi: 10.1097/CCM.0000000000006240. Epub 2024 Feb 22.
To evaluate real-world implications of updated Surviving Sepsis Campaign (SSC) recommendations for antibiotic timing.
Retrospective cohort study.
Twelve hospitals in the Southeastern United States between 2017 and 2021.
One hundred sixty-six thousand five hundred fifty-nine adult hospitalized patients treated in the emergency department for suspected serious infection.
None.
We determined the number and characteristics of patients affected by updated SSC recommendations for initiation of antibiotics that incorporate a risk- and probability-stratified approach. Using an infection prediction model with a cutoff of 0.5 to classify possible vs. probable infection, we found that 30% of the suspected infection cohort would be classified as shock absent, possible infection and thus eligible for the new 3-hour antibiotic recommendation. In real-world practice, this group had a conservative time to antibiotics (median, 5.5 hr; interquartile range [IQR], 3.2-9.8 hr) and low mortality (2%). Patients categorized as shock absent, probable infection had a median time to antibiotics of 3.2 hours (IQR, 2.1-5.1 hr) and mortality of 3%. Patients categorized as shock present, the probable infection had a median time to antibiotics 2.7 hours (IQR, 1.7-4.6 hr) and mortality of 17%, and patients categorized as shock present, the possible infection had a median time to antibiotics 6.9 hours (IQR, 3.5-16.3 hr) and mortality of 12%.
These data support recently updated SSC recommendations to align antibiotic timing targets with risk and probability stratifications. Our results provide empirical support that clinicians and hospitals should not be held to 1-hour targets for patients without shock and with only possible sepsis.
评估更新后的拯救脓毒症运动（SSC）推荐方案对抗生素时机的实际影响。
回顾性队列研究。
2017 年至 2021 年期间美国东南部的 12 家医院。
166559 名在急诊科接受疑似严重感染治疗的成年住院患者。
无。
我们确定了受更新的 SSC 推荐方案影响的患者数量和特征，这些推荐方案采用了风险和概率分层方法来启动抗生素治疗。使用感染预测模型，以 0.5 的截定点对可能感染和可能感染进行分类，我们发现，30%的疑似感染队列将被归类为无休克、可能感染，因此符合新的 3 小时抗生素推荐方案。在实际实践中，该组抗生素的使用时间较为保守（中位数为 5.5 小时；四分位距[IQR]，3.2-9.8 小时），死亡率较低（2%）。被归类为无休克、可能感染的患者使用抗生素的中位数时间为 3.2 小时（IQR，2.1-5.1 小时），死亡率为 3%。被归类为休克存在、可能感染的患者使用抗生素的中位数时间为 2.7 小时（IQR，1.7-4.6 小时），死亡率为 17%；被归类为休克存在、可能感染的患者使用抗生素的中位数时间为 6.9 小时（IQR，3.5-16.3 小时），死亡率为 12%。
这些数据支持最近更新的 SSC 建议，使抗生素时机目标与风险和概率分层保持一致。我们的结果提供了经验证据，表明对于没有休克且只有可能发生脓毒症的患者，临床医生和医院不应该被 1 小时的目标所束缚。
