Garrido Benedicto Pedro M, Cueto Quintana Pitter F, Brito Piris Juan Antonio, Garcia Mañosa Elisabet, Malpica Basurto Karla, Enriquez Sanchez Raquel, Vallverdú Perapoch Immaculada, Camps Andreu Jordi
Intensive Care Unit, Hospital Universitari de Sant Joan, Salut Sant Joan de Reus-Baix Camp, Reus, Spain.
Intensive Care Unit, Hospital Universitari de Sant Joan, Salut Sant Joan de Reus-Baix Camp, Reus, Spain.
J Emerg Med. 2025 Aug;75:137-149. doi: 10.1016/j.jemermed.2025.05.019. Epub 2025 Jun 5.
Delay in administration of antibiotics and surgical control of the infection source are linked to increased mortality in septic patients.
The primary objective was to assess the impact of delays in administering the first antibiotic dose and the timing of surgical control of the infection source on in-hospital mortality.
This single-center, retrospective observational study included 155 critically ill septic patients admitted to hospital emergency department (ED). All patients underwent surgical control of the infection source before admission to the intensive care unit (ICU).
The median time to the first antibiotic dose was 5.6 hours (IQR: 2.5-10.8) and the median time to surgery was 11.3 hours (IQR: 6.7-21.8). Only 28% of patients received antibiotic therapy within the first 3 hours, and 23.2% underwent surgery within the first 6 hours after ED arrival. Mortality rates did not differ significantly between patients who received antibiotics within 3 hours vs. later (25.0% vs. 15.3%, p = 0.158), those with or without septic shock (50.0% vs. 43.3%, p = 0.519), or based on surgical timing (p = 0.085). Older patients exhibited higher mortality (p = 0.036). Multivariate analysis revealed that only patient age, chronic kidney disease (CKD), and a time to surgery of less than 6 hours from hospital arrival were independently associated with mortality. A strong correlation was found between delays in administering the first antibiotic dose and delays in surgery (p < 0.0001).
In our series, septic patients requiring control of the infectious focus did not benefit from the combination of early antibiotic administration and faster surgical intervention. Older age was associated with higher mortality. Additionally, delays in antibiotic administration were strongly correlated with delays in surgical intervention, highlighting the need for streamlined sepsis management protocols.
抗生素给药延迟和感染源的手术控制延迟与脓毒症患者死亡率增加有关。
主要目的是评估首次抗生素给药延迟和感染源手术控制时机对住院死亡率的影响。
这项单中心回顾性观察性研究纳入了155名入住医院急诊科（ED）的重症脓毒症患者。所有患者在入住重症监护病房（ICU）之前均接受了感染源的手术控制。
首次抗生素给药的中位时间为5.6小时（四分位间距：2.5 - 10.8），手术的中位时间为11.3小时（四分位间距：6.7 - 21.8）。只有28%的患者在最初3小时内接受了抗生素治疗，23.2%的患者在到达ED后的最初6小时内接受了手术。在3小时内接受抗生素治疗的患者与之后接受治疗的患者之间（25.0%对15.3%，p = 0.158）、有或没有脓毒症休克的患者之间（50.0%对43.3%，p = 0.519），或基于手术时机（p = 0.085），死亡率没有显著差异。老年患者死亡率更高（p = 0.036）。多因素分析显示，只有患者年龄、慢性肾脏病（CKD）以及从入院到手术时间少于6小时与死亡率独立相关。首次抗生素给药延迟与手术延迟之间存在强烈相关性（p < 0.0001）。
在我们的系列研究中，需要控制感染灶的脓毒症患者并未从早期抗生素给药和更快的手术干预联合治疗中获益。年龄较大与较高死亡率相关。此外，抗生素给药延迟与手术干预延迟密切相关，凸显了简化脓毒症管理方案流程的必要性。
