修订脓毒症定义以更好地靶向并定制脓毒症治疗。

Revising Sepsis Definitions to Better Target and Tailor Sepsis Care.

作者信息

Klompas Michael, Rhee Chanu

机构信息

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

出版信息

Clin Infect Dis. 2025 Jul 18;80(6):1272-1274. doi: 10.1093/cid/ciaf187.

Abstract

How we define sepsis has significant implications for clinical care, quality improvement, and regulatory policies. Current sepsis criteria identify heterogenous patients that vary widely in their clinical syndromes, triggering pathogens, and prognoses; one-third have viral or non-infectious processes and crude mortality rates vary 30-fold. Nonetheless, clinicians have been trained to treat all patients with possible sepsis immediately, aggressively, and uniformly with broad-spectrum antibiotics. Evidence continues to mount, however, that immediate antibiotics are only critical for patients with septic shock or multiorgan dysfunction while, patients with single organ dysfunction without shock can safely tolerate short delays until antibiotics. This allows time to clarify whether these patients are infected or not. We suggest modifying sepsis operational definitions to flag just those patients in whom short antibiotic delays are associated with increased mortality. This will help focus sepsis care where it is needed, aid antibiotic stewardship, and increase the validity of sepsis quality measures.

摘要

我们如何定义脓毒症对临床护理、质量改进和监管政策具有重大影响。当前的脓毒症标准所识别出的患者具有异质性,其临床综合征、引发病原体和预后差异很大;三分之一的患者患有病毒感染或非感染性疾病,粗死亡率相差30倍。尽管如此,临床医生已接受培训,要立即、积极且统一地用广谱抗生素治疗所有可能患有脓毒症的患者。然而,越来越多的证据表明,立即使用抗生素仅对感染性休克或多器官功能障碍的患者至关重要,而没有休克的单器官功能障碍患者可以安全地耐受短时间延迟使用抗生素,这就有时间来明确这些患者是否受到感染。我们建议修改脓毒症的操作定义,仅标记那些短时间延迟使用抗生素会增加死亡率的患者。这将有助于将脓毒症护理集中在需要的地方,有助于抗生素管理,并提高脓毒症质量指标的有效性。

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