Pak Theodore R, Sánchez Sarimer M, McKenna Caroline S, Rhee Chanu, Klompas Michael
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA.
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA.
Crit Care Med. 2024 Dec 1;52(12):1928-1933. doi: 10.1097/CCM.0000000000006428. Epub 2024 Sep 16.
To characterize associations between race/ethnicity/sex, time-to-antibiotics, and mortality in patients with suspected sepsis or septic shock.
Retrospective cohort study, with race/ethnicity/sex as the exposure, and time-to-antibiotics (relative to emergency department arrival) and in-hospital mortality as the outcome.
Five Massachusetts hospitals.
Forty-nine thousand six hundred nine adults admitted 2015-2022 with suspected sepsis or septic shock (blood cultures drawn and IV antibiotics administered within 24 hr of arrival, plus evidence of organ dysfunction for sepsis, and hypotension or lactate ≥ 4.0 mmol/L for septic shock).
None.
Among included patients, 22,598 (46%) were women, 36,626 (75%) were White, and 4,483 (9.2%) were Black. Women had longer median time-to-antibiotics than men when presenting with either suspected sepsis (203 vs. 190 min) or septic shock (160 vs. 142 min). Differences in time-to-antibiotics for women vs. men persisted after adjusting for age, race, comorbidities, source of infection, and severity of illness (adjusted odds ratio [aOR] for 3-6 vs. < 3 hr; 1.16 [95% CI, 1.07-1.25] for sepsis and aOR, 1.09 [95% CI, 1.01-1.18] for septic shock). Median time-to-antibiotics was also longer for Black vs. White patients for both sepsis (215 vs. 194 min; aOR for 3-6 vs. < 3 hr; 1.24 [95% CI, 1.06-1.45]) and septic shock (median 159 vs. 148 min; aOR, 1.32 [95% CI, 1.12-1.55]). There was no association between race/ethnicity/sex and in-hospital mortality for sepsis without shock; however, women with septic shock had higher mortality (aOR, 1.16; 95% CI, 1.04-1.29) vs. men. Higher mortality for women with septic shock persisted when also adjusting for time-to-antibiotics (aOR, 1.16; 95% CI, 1.03-1.32).
In a large cohort of patients with sepsis, time-to-antibiotics was longer for both women and Black patients even after detailed risk-adjustment. Women with septic shock had higher adjusted in-hospital mortality than men, but this association was not moderated by time-to-antibiotics.
描述疑似脓毒症或脓毒性休克患者的种族/族裔/性别、抗生素使用时间与死亡率之间的关联。
回顾性队列研究，以种族/族裔/性别为暴露因素，抗生素使用时间（相对于急诊科就诊时间）和住院死亡率为结局指标。
马萨诸塞州的五家医院。
2015年至2022年期间收治的49609例疑似脓毒症或脓毒性休克的成年人（到达后24小时内进行血培养并静脉使用抗生素，同时有脓毒症器官功能障碍的证据，以及脓毒性休克的低血压或乳酸≥4.0 mmol/L）。
无。
在纳入的患者中，22598例（46%）为女性，36626例（75%）为白人，4483例（9.2%）为黑人。无论是疑似脓毒症（203分钟对190分钟）还是脓毒性休克（160分钟对142分钟），女性的抗生素使用中位时间均长于男性。在调整年龄、种族、合并症、感染源和疾病严重程度后，女性与男性在抗生素使用时间上的差异仍然存在（脓毒症3 - 6小时对<3小时的调整优势比[aOR]为1.16[95%CI，1.07 - 1.25]，脓毒性休克的aOR为1.09[95%CI，1.01 - 1.18]）。对于脓毒症和脓毒性休克，黑人患者的抗生素使用中位时间也长于白人患者（脓毒症：215分钟对194分钟；3 - 6小时对<3小时的aOR为1.24[95%CI，1.06 - 1.45]；脓毒性休克：中位时间159分钟对148分钟；aOR为1.32[95%CI，1.12 - 1.55]）。对于无休克的脓毒症，种族/族裔/性别与住院死亡率之间无关联；然而，脓毒性休克女性的死亡率高于男性（aOR为1.16；95%CI，1.04 - 1.29）。在调整抗生素使用时间后，脓毒性休克女性的较高死亡率仍然存在（aOR为1.16；95%CI，1.03 - 1.32）。
在一大群脓毒症患者中，即使经过详细的风险调整，女性和黑人患者的抗生素使用时间仍较长。脓毒性休克女性的调整后住院死亡率高于男性，但这种关联不受抗生素使用时间的影响。
