Philippon Anne-Laure, Lebal Soufiane, Cancella de Abreu Marta, Gerlier Camille, Mirò Oscar, Simon Tabassome, Freund Yonathan
Sorbonne Université, IMProving Emergency Care (IMPEC) FHU Paris.
Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP).
Eur J Emerg Med. 2025 Apr 1;32(2):109-115. doi: 10.1097/MEJ.0000000000001212. Epub 2024 Dec 23.
The impact of early antibiotics on mortality in patients with suspected sepsis in the emergency department (ED) remains debated, particularly in patients with less severe presentations or before infection confirmation.
To evaluate the association between time to antibiotic administration and 28-day in-hospital mortality among patients with suspected sepsis in the ED.
DESIGN, SETTING, AND PARTICIPANTS: Post hoc analysis of the 1-bundle emergency department trial, a multicenter, stepped-wedge cluster-randomized controlled trial conducted in 23 EDs in France and Spain. A total of 872 patients with suspected sepsis were included between June 2022 and September 2023. All patients with available data on antibiotic administration were analyzed, and a subgroup of patients with no hypotension was also assessed.
Time to antibiotic administration. The effect of time to fluid resuscitation was also assessed.
The primary outcome was in-hospital mortality at 28 days. Secondary outcomes included all-cause 28-day mortality, ICU length of stay, number of days without vasopressors at day 28, and change in Sequential Organ Failure Assessment score at 72 h.
Among 872 patients (mean age 66 years; 41% female), 859 had available data on antibiotic administration (primary analysis) and 791 (92%) received antibiotics. The median time to antibiotic administration was 61 min (IQR 14-169), with 457 patients (58%) receiving antibiotics within 1 h. In-hospital mortality at 28 days was 14.7% for patients who did not received antibiotic within 1 h versus 9.6% for patients who did [adjusted odds ratio (aOR) 2.00 (1.24-3.23)]. There was an aOR of 1.06 (1.02-1.1) for each hour of delay for antibiotic administration. This effect was confirmed in patients without hypotension [aOR 2.02 (1.08-3.76) for patients who received antibiotics beyond 1 h]. Time to fluid resuscitation was not associated with 28-day in-hospital mortality.
In patients with suspected sepsis presenting to the ED antibiotic administration beyond 1 h was associated with a two-fold increased 28-day in-hospital mortality. This effect persisted in patients without hypotension.
早期使用抗生素对急诊科疑似脓毒症患者死亡率的影响仍存在争议，尤其是在症状较轻的患者或感染确诊之前。
评估急诊科疑似脓毒症患者抗生素给药时间与28天院内死亡率之间的关联。
设计、地点和参与者：对1-束急诊科试验进行事后分析，这是一项在法国和西班牙的23个急诊科开展的多中心、阶梯式楔形整群随机对照试验。2022年6月至2023年9月期间共纳入872例疑似脓毒症患者。对所有有抗生素给药可用数据的患者进行分析，还评估了一个无低血压的患者亚组。
抗生素给药时间。还评估了液体复苏时间的影响。
主要结局是28天的院内死亡率。次要结局包括全因28天死亡率、重症监护病房住院时间、第28天无血管升压药使用天数，以及72小时时序贯器官衰竭评估评分的变化。
在872例患者（平均年龄66岁；41%为女性）中，859例有抗生素给药的可用数据（主要分析），791例（92%）接受了抗生素治疗。抗生素给药的中位时间为61分钟（四分位间距14-169），457例患者（58%）在1小时内接受了抗生素治疗。1小时内未接受抗生素治疗的患者28天院内死亡率为14.7%，而接受了抗生素治疗的患者为9.6%[调整后的优势比（aOR）为2.00（1.24-3.23）]。抗生素给药每延迟1小时，aOR为1.06（1.02-1.1）。在无低血压的患者中也证实了这种效应[超过1小时接受抗生素治疗的患者aOR为2.02（1.08-3.76）]。液体复苏时间与28天院内死亡率无关。
在急诊科就诊的疑似脓毒症患者中，超过1小时给予抗生素与28天院内死亡率增加两倍相关。这种效应在无低血压的患者中持续存在。
