Delay in the administration of appropriate antimicrobial therapy in Staphylococcus aureus bloodstream infection: a prospective multicenter hospital-based cohort study
Delay in the administration of appropriate antimicrobial therapy in Staphylococcus aureus bloodstream infection: a prospective multicenter hospital-based cohort study
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DOI：
10.1007/s15010-013-0428-9
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发表时间：
2013-10-01
期刊：
影响因子：
7.5
通讯作者：
Seifert, H.
中科院分区：
文献类型：
--
作者：
Kaasch, A. J.;Rieg, S.;Seifert, H.
早期广谱抗菌药治疗可降低感染性休克患者的死亡率。在一项多中心的前瞻性观察研究中，我们探讨了延迟适当的抗菌治疗(AAT)是否会影响金黄色葡萄球菌血流感染(SAB)的预后。记录易感因素、临床特征、诊断程序、抗菌治疗和结果。抗菌治疗的适宜性由训练有素的医生根据体外活性、剂量和治疗持续时间来判断。当第一次血培养阳性和开始适当治疗之间的时间超过24小时时，治疗被认为是延迟的。延迟治疗与总死亡率和SAB相关事件(即归因性死亡率或晚期SAB相关并发症)的相关性通过交叉统计法和基于倾向评分的Logistic回归进行评估。168名患者在住院期间接受了AAT，其中42名(25%)接受了延迟AAT。延迟AAT患者的总死亡率和严重脓毒症或感染性休克的发生率较低，这表明适应症有混淆的倾向。调整后的90天死亡率(调整后的优势比[OR]0.91，95%可信区间[0.39-2.13]，p 0.82)和SAB相关事件(调整后的优势比1.46，95%CI[0.47-4.51]，p 0.52)也未能显示延迟AAT对预后的显著影响。然而，在分析和解释关于延迟AAT影响的观察性研究时，指征混淆是一个主要挑战。
Early broad-spectrum antimicrobial treatment reduces mortality in patients with septic shock. In a multicenter, prospective observational study, we explored whether delayed appropriate antimicrobial therapy (AAT) influences outcome in Staphylococcus aureus bloodstream infection (SAB).Two hundred and fifty-six patients with SAB from ten German study centers were enrolled and followed for 3 months. Predisposing factors, clinical features, diagnostic procedures, antimicrobial therapy, and outcome were recorded. The appropriateness of antimicrobial therapy was judged by a trained physician based on in vitro activity, dosage, and duration of therapy. Therapy was considered to be delayed when more than 24 h elapsed between the first positive blood culture and the start of appropriate therapy. The association of delayed therapy with overall mortality and SAB-related events (i.e., attributable mortality or late SAB-related complications) was assessed by crosstabulation and propensity score-based logistic regression.One hundred and sixty-eight patients received AAT during their hospital stay, of whom 42 (25 %) received delayed AAT. The overall mortality and the occurrence of severe sepsis or septic shock were lower in patients with delayed AAT, pointing towards confounding by indication. Adjusted 90-day mortality (adjusted odds ratio [OR] 0.91, 95 % confidence interval [CI] [0.39-2.13], p 0.82) and SAB-related events (adjusted OR 1.46, 95 % CI [0.47-4.51], p 0.52) also failed to show a significant impact of delayed AAT on outcome.In patients with SAB, early AAT may not improve survival. However, confounding by indication is a major challenge when analyzing and interpreting observational studies on the impact of delayed AAT.