The Impact of Timing of Antibiotics on Outcomes in Severe Sepsis and Septic Shock: A Systematic Review and Meta-Analysis.
The Impact of Timing of Antibiotics on Outcomes in Severe Sepsis and Septic Shock: A Systematic Review and Meta-Analysis.
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DOI：
10.1097/ccm.0000000000001142
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发表时间：
2015-09
影响因子：
8.8
通讯作者：
Jones AE
中科院分区：
文献类型：
--
作者：
Sterling SA;Miller WR;Pryor J;Puskarich MA;Jones AE
我们试图系统地回顾和荟萃分析抗生素给药时间与严重脓毒症和脓毒性休克死亡率之间关系的现有数据。使用预定义的协议进行了全面的搜索。入选标准：严重脓毒症或脓毒性休克的成人患者，报告了与艾德分类和/或休克识别相关的抗生素给药时间和死亡率。排除标准：免疫抑制人群、综述文章、社论或非人类研究。两名评审员筛选摘要，第三名评审员进行仲裁。至抗生素给药时间对死亡率的影响基于当前指南的建议：1）在艾德分类后3小时内给药; 2）在严重脓毒症/脓毒性休克识别后1小时内给药。使用随机效应模型计算比值比（OR）。主要结局为死亡率。共识别出1123篇出版物，其中11篇纳入分析。在纳入的11项研究中，16，178例患者可从艾德分诊中评价抗生素给药。在艾德分诊后超过3小时（< 3小时参考）接受抗生素治疗的患者，死亡率的合并OR为1.16（0.92至1.46，p = 0.21）。共有11，017例患者可评价严重脓毒症/脓毒性休克识别的抗生素给药。在严重脓毒症/休克识别后超过1小时（< 1小时参考）接受抗生素治疗的患者死亡率的合并OR为1.46（0.89至2.40，p = 0.13）。在合并OR中，<1 to >从严重脓毒症/休克识别开始的抗生素给药5小时每小时延迟一次，死亡率没有增加。使用现有的汇总数据，我们发现在严重脓毒症和脓毒性休克中，在艾德分诊3小时内或休克识别1小时内给予抗生素没有显著的死亡率获益。这些结果表明，目前推荐的时间指标作为护理质量的措施是不支持现有的证据。
We sought to systematically review and meta-analyze the available data on the association between timing of antibiotic administration and mortality in severe sepsis and septic shock. A comprehensive search was performed using a pre-defined protocol. Inclusion criteria: adult patients with severe sepsis or septic shock, reported time to antibiotic administration in relation to ED triage and/or shock recognition, and mortality. Exclusion criteria: immunosuppressed populations, review article, editorial, or non-human studies. Two reviewers screened abstracts with a third reviewer arbitrating. The effect of time to antibiotic administration on mortality was based on current guideline recommendations: 1) administration within 3 hours of ED triage; 2) administration within 1 hour of severe sepsis/septic shock recognition. Odds Ratios (OR) were calculated using a random effect model. The primary outcome was mortality. 1123 publications were identified and 11 were included in the analysis. Among the 11 included studies, 16,178 patients were evaluable for antibiotic administration from ED triage. Patients who received antibiotics more than 3 hours after ED triage (< 3 hours reference), had a pooled OR for mortality of 1.16 (0.92 to 1.46, p = 0.21). A total of 11,017 patients were evaluable for antibiotic administration from severe sepsis/septic shock recognition. Patients who received antibiotics more than 1 hour after severe sepsis/shock recognition (< 1 hour reference) had a pooled OR for mortality of 1.46 (0.89 to 2.40, p = 0.13). There was no increased mortality in the pooled ORs for each hourly delay from <1 to >5 hours in antibiotic administration from severe sepsis/shock recognition. Using the available pooled data we found no significant mortality benefit of administering antibiotics within 3 hours of ED triage or within 1 hour of shock recognition in severe sepsis and septic shock. These results suggest that currently recommended timing metrics as measures of quality of care are not supported by the available evidence.