The Timing of Early Antibiotics and Hospital Mortality in Sepsis
The Timing of Early Antibiotics and Hospital Mortality in Sepsis
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DOI：
10.1164/rccm.201609-1848oc
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发表时间：
2017-10-01
影响因子：
24.7
通讯作者：
Escobar, Gabriel J.
中科院分区：
文献类型：
--
作者：
Liu, Vincent X.;Fielding-Singh, Vikram;Escobar, Gabriel J.
理由：先前的脓毒症研究评估了抗生素的使用时间，结果好坏参半。目的：评估急诊科登记后6小时内接受抗生素治疗的脓毒症患者抗生素使用时间与死亡率之间的关系。方法：对2010年至2013年在北加州21个急诊科随机抽取的35000例败血症住院患者进行回顾性研究。主要暴露是在急诊室登记后6小时内给予抗生素。主要终点是调整后的住院死亡率。我们使用详细的生理数据来量化登记后1小时内疾病的严重程度，并使用逻辑回归来估计基于抗生素使用时间和患者因素的住院死亡率。测量和主要结果：抗生素给药的中位时间为2.1小时（四分位数范围为1.4-3.1小时）。登记后每小时延迟使用抗生素的调整优势比为1.09（95%可信区间[CI]， 1.05-1.13）。延迟1小时给药导致脓毒症患者绝对死亡率增加0.3% (95% CI, 0.01-0.6%; P = 0.04)，严重脓毒症患者死亡率增加0.4% (95% CI, 0.1-0.8%; P = 0.02)，休克患者死亡率增加1.8% （95% CI, 0.8-3.0%; P = 0.001）。结论：在一项对急诊脓毒症患者的大型、当代和多中心样本中，即使在6小时内接受抗生素治疗的患者中，每小时延迟给药与医院死亡率增加有关。在每个脓毒症严重程度层中，死亡率增加的几率都在增加，而脓毒症休克的死亡率增加的几率最大。
Rationale: Prior sepsis studies evaluating antibiotic timing have shown mixed results.Objectives: To evaluate the association between antibiotic timing and mortality among patients with sepsis receiving antibiotics within 6 hours of emergency department registration.Methods: Retrospective study of 35,000 randomly selected inpatients with sepsis treated at 21 emergency departments between 2010 and 2013 in Northern California. The primary exposure was antibiotics given within 6 hours of emergency department registration. The primary outcome was adjusted in-hospital mortality. We used detailed physiologic data to quantify severity of illness within 1 hour of registration and logistic regression to estimate the odds of hospital mortality based on antibiotic timing and patient factors.Measurements and Main Results: The median time to antibiotic administration was 2.1 hours (interquartile range, 1.4-3.1 h). The adjusted odds ratio for hospital mortality based on each hour of delay in antibiotics after registration was 1.09 (95% confidence interval [CI], 1.05-1.13) for each elapsed hour between registration and antibiotic administration. The increase in absolute mortality associated with an hour's delay in antibiotic administration was 0.3% (95% CI, 0.01-0.6%; P = 0.04) for sepsis, 0.4% (95% CI, 0.1-0.8%; P = 0.02) for severe sepsis, and 1.8% (95% CI, 0.8-3.0%; P = 0.001) for shock.Conclusions: In a large, contemporary, and multicenter sample of patients with sepsis in the emergency department, hourly delays in antibiotic administration were associated with increased odds of hospital mortality even among patients who received antibiotics within 6 hours. The odds increased within each sepsis severity strata, and the increased odds of mortality were greatest in septic shock.