Hill Terra M, Kerivan Lauren T, Vilain Katherine A, Windham Sam, Sarani Nima, Simpson Steven Q, Guidry Christopher A
Department of Surgery, University of Kansas Medical Center, Kansas City, USA.
Saint Luke's Hospital Cardiovascular and Cardiothoracic Research, Kansas City, USA.
Intensive Care Med. 2025 Apr 29. doi: 10.1007/s00134-025-07899-w.
Sepsis remains a major health concern with high associated mortality. Adequate treatment involves the use of antibiotic therapy although the timing of antibiotics is controversial. A decision analysis model of antibiotic initiation was created to determine optimal management of patients with suspected sepsis.
Two decision trees were created using data from the published literature. A limited model used mortality as the primary outcome using the impact of antibiotic timing on rates of progression to shock and in-hospital mortality. The primary model included mortality and stewardship-related factors such as antibiotic avoidance and antibiotic-associated adverse events. Rapid initiation of antibiotics was defined as universal antibiotic administration within 3 h of presentation whereas deferred initiation included administration up to 6 h. Sensitivity analyses were performed to evaluate the effectiveness of each option.
When considering only mortality, rapid initiation was the optimal strategy. When considering stewardship-related factors, rapid initiation of antibiotics maximized utility in only 40.6% of model iterations. One-way sensitivity analysis demonstrated rapid initiation of antibiotics was optimal when initiation times were above 1.33 h and the prevalence of infection was above 89.5%. Two-way sensitivity analysis demonstrated that as time to antibiotics increased, rate of true infection above which rapid antibiotics is optimal drops from just under 91% to approximately 88.5%.
We constructed decision analysis models to characterize optimal conditions for antibiotic initiation in suspected sepsis. Our model suggests that the prevalence of infection needs to be approximately 90% for rapid initiation of antibiotics to be the optimal strategy.
脓毒症仍然是一个主要的健康问题，死亡率很高。充分的治疗包括使用抗生素治疗，尽管抗生素的使用时机存在争议。建立了一个抗生素起始治疗的决策分析模型，以确定疑似脓毒症患者的最佳管理方案。
利用已发表文献中的数据创建了两个决策树。一个有限模型将死亡率作为主要结果，采用抗生素使用时机对休克进展率和住院死亡率的影响。主要模型包括死亡率和与管理相关的因素，如避免使用抗生素和抗生素相关不良事件。抗生素的快速起始治疗定义为在就诊后3小时内普遍使用抗生素，而延迟起始治疗包括在6小时内给药。进行敏感性分析以评估每种方案的有效性。
仅考虑死亡率时，快速起始治疗是最佳策略。考虑到与管理相关的因素，在仅40.6%的模型迭代中，抗生素的快速起始治疗使效用最大化。单向敏感性分析表明，当起始时间超过1.33小时且感染患病率超过89.5%时，抗生素的快速起始治疗是最佳的。双向敏感性分析表明，随着抗生素使用时间的增加，快速使用抗生素为最佳选择的真实感染率从略低于91%降至约88.5%。
我们构建了决策分析模型来描述疑似脓毒症中抗生素起始治疗的最佳条件。我们的模型表明，对于抗生素的快速起始治疗要成为最佳策略，感染患病率需要约为90%。
