Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study.
Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study.
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DOI：
10.1186/cc13755
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发表时间：
2014-03-03
期刊：
影响因子：
--
通讯作者：
MEDUSA Study Group
中科院分区：
文献类型：
--
作者：
Bloos F;Thomas-Rüddel D;Rüddel H;Engel C;Schwarzkopf D;Marshall JC;Harbarth S;Simon P;Riessen R;Keh D;Dey K;Weiß M;Toussaint S;Schädler D;Weyland A;Ragaller M;Schwarzkopf K;Eiche J;Kuhnle G;Hoyer H;Hartog C;Kaisers U;Reinhart K;MEDUSA Study Group
目前的脓毒症指南建议在脓毒症相关器官功能障碍（OD）发作后1小时内进行抗菌治疗（AT），并在12小时内进行手术源控制。本研究的目的是探讨根据脓毒症治疗建议进行初始感染管理与患者结局之间的相关性。在44个德国ICU的前瞻性观察性多中心队列研究中，我们研究了1,011例严重脓毒症或脓毒性休克患者的AT时间、源控制和AT充分性。主要结局为28天死亡率。至AT的中位时间为2.1（IQR 0.8 - 6.0）小时，至手术源控制的中位时间为3小时（-0.1-13.7）。仅370例（36.6%）患者在OD后1小时内接受AT。在422例接受手术或介入性源控制的患者中，在OD发作后6小时后接受源控制的患者的28天死亡率显著高于早期源控制的患者（42.9%对26.7%，P <0.001）。ICU和医院死亡者的AT时间显著延长; AT时间与28天死亡率之间无线性关系。无论何时，AT充分的患者28天死亡率低于AT不充分的患者（30.3%对40.9%，P < 0.001）。源控制延迟超过6小时可能对患者死亡率产生重大影响。适当的AT与改善患者结局相关，但对指南建议的依从性需要改善。只有间接证据表明AT的时间对脓毒症死亡率的影响。
Current sepsis guidelines recommend antimicrobial treatment (AT) within one hour after onset of sepsis-related organ dysfunction (OD) and surgical source control within 12 hours. The objective of this study was to explore the association between initial infection management according to sepsis treatment recommendations and patient outcome. In a prospective observational multi-center cohort study in 44 German ICUs, we studied 1,011 patients with severe sepsis or septic shock regarding times to AT, source control, and adequacy of AT. Primary outcome was 28-day mortality. Median time to AT was 2.1 (IQR 0.8 – 6.0) hours and 3 hours (-0.1 – 13.7) to surgical source control. Only 370 (36.6%) patients received AT within one hour after OD in compliance with recommendation. Among 422 patients receiving surgical or interventional source control, those who received source control later than 6 hours after onset of OD had a significantly higher 28-day mortality than patients with earlier source control (42.9% versus 26.7%, P <0.001). Time to AT was significantly longer in ICU and hospital non-survivors; no linear relationship was found between time to AT and 28-day mortality. Regardless of timing, 28-day mortality rate was lower in patients with adequate than non-adequate AT (30.3% versus 40.9%, P < 0.001). A delay in source control beyond 6 hours may have a major impact on patient mortality. Adequate AT is associated with improved patient outcome but compliance with guideline recommendation requires improvement. There was only indirect evidence about the impact of timing of AT on sepsis mortality.
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影响因子：
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作者：
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