急诊科疑似脓毒症患者抗生素过度治疗的频率及相关危害：一项回顾性队列研究

Frequency of Antibiotic Overtreatment and Associated Harms in Patients Presenting With Suspected Sepsis to the Emergency Department: A Retrospective Cohort Study.

作者信息

Shappell Claire N, Yu Tingting, Klompas Michael, Agan Anna A, DelloStritto Laura, Faine Brett A, Filbin Michael R, Mohr Nicholas M, Park Steven T, Plechot Kamryn, Porter Emily, Roach David, Train Sarah E, Zepeski Anne, Rhee Chanu

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

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

出版信息

Clin Infect Dis. 2025 Jul 18;80(6):1197-1207. doi: 10.1093/cid/ciaf118.

DOI:10.1093/cid/ciaf118

PMID:40231968

Abstract

BACKGROUND

Treatment guidelines recommend rapidly treating all patients with suspected sepsis with broad-spectrum antibiotics. This may contribute to antibiotic overuse. We quantified the incidence of antibiotic overtreatment and possible antibiotic-associated harms among patients with suspected sepsis.

METHODS

We reviewed the medical records of 600 adults treated for suspected sepsis with anti-methicillin-resistant Staphylococcus aureus and/or antipseudomonal β-lactam antibiotics in the emergency departments of 7 hospitals, 2019-2022, to assess their post hoc likelihood of infection, whether narrower antibiotics would have sufficed in retrospect, and possible antibiotic-associated complications. We used generalized estimating equations to assess associations between likelihood of infection and hospital mortality.

RESULTS

Of 600 patients, 411 (68.5%) had definite (48.0%) or probable (20.5%) bacterial infection and 189 (31.5%) had possible but less likely (18.3%) or definitely no (13.2%) bacterial infection. Among patients with definite/probable bacterial infection, 325 of 411 (79.1%) received antibiotics that were overly broad in retrospect. Potential antibiotic-associated complications developed in 104 of 600 (17.3%) patients within 90 days, most commonly new infection or colonization with organisms resistant to first-line agents (48/600 [8.0%]). Mortality was higher for patients with less likely/definitely no bacterial infection versus definite/probable bacterial infections (9.0% vs 4.9%; adjusted odds ratio [aOR], 2.25 [95% confidence interval{CI}, 1.70-2.98]), but antibiotic-associated complication rates were similar (14.8% vs 18.5%; aOR, 0.79 [95% CI, .60-1.05]).

CONCLUSIONS

Among 600 patients treated with broad-spectrum antibiotics for possible sepsis, 1 in 3 most likely did not have a bacterial infection, 4 in 5 of those with bacterial infections were treated with regimens that were broader than necessary in retrospect, and 1 in 6 developed antibiotic-associated complications.

摘要

背景

治疗指南建议对所有疑似脓毒症患者迅速使用广谱抗生素进行治疗。这可能会导致抗生素的过度使用。我们对疑似脓毒症患者中抗生素过度治疗的发生率以及可能的抗生素相关危害进行了量化。

方法

我们回顾了2019年至2022年期间在7家医院急诊科接受抗耐甲氧西林金黄色葡萄球菌和/或抗假单胞菌β-内酰胺类抗生素治疗的600名成年疑似脓毒症患者的病历，以评估他们事后感染的可能性、回顾性来看使用更窄谱的抗生素是否足够，以及可能的抗生素相关并发症。我们使用广义估计方程来评估感染可能性与医院死亡率之间的关联。

结果

在600名患者中，411名（68.5%）患有确诊（48.0%）或很可能（20.5%）的细菌感染，189名（31.5%）可能但可能性较小（18.3%）或肯定没有（13.2%）细菌感染。在确诊/很可能患有细菌感染的患者中，411名中有325名（79.1%）回顾性来看接受了过度广谱的抗生素治疗。600名患者中有104名（17.3%）在90天内出现了潜在的抗生素相关并发症，最常见的是对一线药物耐药的新感染或定植（48/600 [8.0%]）。可能性较小/肯定没有细菌感染的患者的死亡率高于确诊/很可能患有细菌感染的患者（9.0%对4.9%；调整后的优势比[aOR]，2.25 [95%置信区间{CI}，1.70 - 2.98]），但抗生素相关并发症发生率相似（14.8%对18.5%；aOR，0.79 [95% CI，0.60 - 1.05]）。