Quantifying the breadth of antibiotic exposure in sepsis and suspected infection using spectrum scores.
Quantifying the breadth of antibiotic exposure in sepsis and suspected infection using spectrum scores.
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DOI：
10.1097/md.0000000000030245
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发表时间：
2022-10-14
期刊：
影响因子：
1.6
通讯作者：
Liu, Vincent X.
中科院分区：
文献类型：
--
作者：
Smith, Joshua T.;Manickam, Raj N.;Barreda, Fernando;Greene, John D.;Bhimarao, Meghana;Pogue, Jason;Jones, Makoto;Myers, Laura;Prescott, Hallie C.;Liu, Vincent X.
关键词：
一项回顾性队列研究。量化人群抗生素暴露广度的研究仍然有限。因此，我们采用了一种经过验证的方法来描述疑似感染和败血症患者的多中心队列中抗菌药物覆盖的广度。我们对综合医疗保健服务系统内的 21 家医院进行了一项回顾性队列研究，研究对象为 2012 年 1 月 1 日至 2017 年 12 月 31 日期间通过急诊科入院的疑似感染或脓毒症患者，并在住院期间接受抗生素治疗。我们利用电子健康记录数据，使用频谱评分（0 到 64 的数字评分）对疑似感染和脓毒症患者的抗菌药物覆盖范围进行了量化。在通过急诊科入院的 364,506 例患者中，我们发现 159,004 例（43.6%）疑似感染，205,502 例（56.4%）患有败血症。与疑似感染患者相比，脓毒症患者的住院死亡率更高（8.4% vs 1.2%；P < .001）。脓毒症患者的总体谱评分中位数较高（43.8 [四分位数范围 IQR 32.0–49.5] vs 43.5 [IQR 26.8–47.2]；P < .001）和附加谱评分（114.0 [IQR 57.0–204.5] vs 87.5 [IQR 45.0–144.8]；P < .001) 与疑似感染者相比。即使在协变量调整后，频谱评分的增加与住院患者死亡率相关（频谱评分每增加 10 点，调整后的比值比为 1.31；95%CI 1.29–1.33）。谱评分量化了个体患者、疑似感染者和脓毒症人群之间、住院期间以及感染源之间抗生素广度的变异性。它们可能在量化疑似感染和脓毒症患者抗生素处方的变化方面发挥关键作用。
A retrospective cohort study. Studies to quantify the breadth of antibiotic exposure across populations remain limited. Therefore, we applied a validated method to describe the breadth of antimicrobial coverage in a multicenter cohort of patients with suspected infection and sepsis. We conducted a retrospective cohort study across 21 hospitals within an integrated healthcare delivery system of patients admitted to the hospital through the ED with suspected infection or sepsis and receiving antibiotics during hospitalization from January 1, 2012, to December 31, 2017. We quantified the breadth of antimicrobial coverage using the Spectrum Score, a numerical score from 0 to 64, in patients with suspected infection and sepsis using electronic health record data. Of 364,506 hospital admissions through the emergency department, we identified 159,004 (43.6%) with suspected infection and 205,502 (56.4%) with sepsis. Inpatient mortality was higher among those with sepsis compared to those with suspected infection (8.4% vs 1.2%; P < .001). Patients with sepsis had higher median global Spectrum Scores (43.8 [interquartile range IQR 32.0–49.5] vs 43.5 [IQR 26.8–47.2]; P < .001) and additive Spectrum Scores (114.0 [IQR 57.0–204.5] vs 87.5 [IQR 45.0–144.8]; P < .001) compared to those with suspected infection. Increased Spectrum Scores were associated with inpatient mortality, even after covariate adjustments (adjusted odds ratio per 10-point increase in Spectrum Score 1.31; 95%CI 1.29–1.33). Spectrum Scores quantify the variability in antibiotic breadth among individual patients, between suspected infection and sepsis populations, over the course of hospitalization, and across infection sources. They may play a key role in quantifying the variation in antibiotic prescribing in patients with suspected infection and sepsis.