Clinical Medical Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
Crit Care. 2024 May 24;28(1):176. doi: 10.1186/s13054-024-04963-7.
Bacteraemia is a critical condition that generally leads to substantial morbidity and mortality. It is unclear whether delayed antimicrobial therapy (and/or source control) has a prognostic or defervescence effect on patients with source-control-required (ScR) or unrequired (ScU) bacteraemia.
The multicenter cohort included treatment-naïve adults with bacteraemia in the emergency department. Clinical information was retrospectively obtained and etiologic pathogens were prospectively restored to accurately determine the time-to-appropriate antibiotic (TtAa). The association between TtAa or time-to-source control (TtSc, for ScR bacteraemia) and 30-day crude mortality or delayed defervescence were respectively studied by adjusting independent determinants of mortality or delayed defervescence, recognised by a logistic regression model.
Of the total 5477 patients, each hour of TtAa delay was associated with an average increase of 0.2% (adjusted odds ratio [AOR], 1.002; P < 0.001) and 0.3% (AOR 1.003; P < 0.001) in mortality rates for patients having ScU (3953 patients) and ScR (1524) bacteraemia, respectively. Notably, these AORs were augmented to 0.4% and 0.5% for critically ill individuals. For patients experiencing ScR bacteraemia, each hour of TtSc delay was significantly associated with an average increase of 0.31% and 0.33% in mortality rates for overall and critically ill individuals, respectively. For febrile patients, each additional hour of TtAa was significantly associated with an average 0.2% and 0.3% increase in the proportion of delayed defervescence for ScU (3085 patients) and ScR (1266) bacteraemia, respectively, and 0.5% and 0.9% for critically ill individuals. For 1266 febrile patients with ScR bacteraemia, each hour of TtSc delay respectively was significantly associated with an average increase of 0.3% and 0.4% in mortality rates for the overall population and those with critical illness.
Regardless of the need for source control in cases of bacteraemia, there seems to be a significant association between the prompt administration of appropriate antimicrobials and both a favourable prognosis and rapid defervescence, particularly among critically ill patients. For ScR bacteraemia, delayed source control has been identified as a determinant of unfavourable prognosis and delayed defervescence. Moreover, this association with patient survival and the speed of defervescence appears to be augmented among critically ill patients.
菌血症是一种严重的病症，通常会导致较高的发病率和死亡率。目前尚不清楚延迟使用抗生素治疗（和/或进行源头控制）对需要进行源头控制（ScR）或不需要进行源头控制（ScU）的菌血症患者的预后或退热效果是否有影响。
这项多中心队列研究纳入了急诊科中治疗初治的菌血症成年患者。回顾性地获取临床信息，并前瞻性地恢复病原体，以准确确定适当抗生素的使用时间（TtAa）。通过调整由逻辑回归模型识别的死亡率或延迟退热的独立决定因素，分别研究 TtAa 或源头控制时间（TtSc，适用于 ScR 菌血症）与 30 天粗死亡率或延迟退热之间的关系。
在总计 5477 例患者中，对于 ScU（3953 例）和 ScR（1524 例）菌血症患者，TtAa 每延迟 1 小时，死亡率分别平均增加 0.2%（校正比值比 [AOR]，1.002；P<0.001）和 0.3%（AOR，1.003；P<0.001）。值得注意的是，对于重症患者，这些 AOR 分别增加至 0.4%和 0.5%。对于发生 ScR 菌血症的患者，TtSc 每延迟 1 小时，总死亡率和重症患者死亡率分别平均增加 0.31%和 0.33%。对于发热患者，TtAa 每增加 1 小时，ScU（3085 例）和 ScR（1266 例）菌血症患者的退热延迟比例分别平均增加 0.2%和 0.3%，重症患者分别增加 0.5%和 0.9%。对于 1266 例发热 ScR 菌血症患者，TtSc 每延迟 1 小时，分别平均增加整体人群和重症患者的死亡率 0.3%和 0.4%，增加重症患者的死亡率 0.5%和 0.9%。
无论菌血症是否需要进行源头控制，及时使用适当的抗生素似乎与良好的预后和快速退热显著相关，特别是在重症患者中。对于 ScR 菌血症，延迟源头控制已被确定为预后不良和退热延迟的决定因素。此外，这种与患者生存率和退热速度的关联似乎在重症患者中更为明显。
