Association of patient characteristics and antibiotic timing with the development of acute respiratory failure in hospital-acquired sepsis

患者特征和抗生素使用时机与医院获得性脓毒症急性呼吸衰竭发展的关系

• 批准号: 10313769
• 负责人: Jennifer Claire Ginestra
• 金额: $ 7.89万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10313769
• 关键词: Association; patient; characteristics; antibiotic; timing

Project Summary Acute respiratory failure and sepsis are the leading causes of critical illness and death in hospitalized patients. Patients who become septic during hospitalization are at high risk of developing acute respiratory failure: up to 50% require mechanical ventilation. Sepsis patients with lung injury and respiratory failure have more than double the mortality of those without respiratory failure, but little is known about how to prevent this important complication in hospital-acquired sepsis. Guidelines recommend initiating antibiotics within one hour for all septic patients, but these recommendations rely on evidence primarily from patients with community-acquired sepsis, a population known to differ in characteristics, risks, and outcomes from patients with hospital-acquired sepsis. Furthermore, patients with hospital-acquired sepsis have well-documented delays in sepsis care and infrequently achieve quality targets for antibiotic timing. Critical knowledge gaps exist regarding determinants and implications of antibiotic timing among patients with hospital-acquired sepsis, limiting our ability to prevent the development of acute respiratory failure and other adverse outcomes in this high-risk population. The goals of this study are to identify the characteristics of patients’ clinical presentation associated with antibiotic timing in hospital-acquired sepsis, and to evaluate the role of antibiotic timing in reducing the risk of respiratory failure. First, using a retrospective cohort of approximately 1,800 inpatients with hospital-acquired sepsis, we will test the association of patient-level clinical factors at time of sepsis onset with time to antibiotic initiation. Second, we will test the association of antibiotic timing with the development of acute respiratory failure, using applied regression and instrumental variable methods. This project is supported by the Palliative and Advanced Illness Research (PAIR) Center of the University of Pennsylvania, which has an outstanding track record of supporting and advancing the careers of health services researchers in training. The candidate will be intensively mentored by a team with expertise in acute respiratory failure, sepsis, resource strain, and causal inference methods. Experiential training through this project will be complemented with coursework in applied regression and time-to-event analysis. Findings from this work will directly inform the development of an application for a K23 Mentored Career Development Award that aims to identify important sepsis clinical subgroups in order to improve the timeliness of sepsis care and our ability to prevent progression to respiratory failure.

项目摘要 急性呼吸衰竭和败血症是住院患者危重病和死亡的主要原因。 住院期间发生脓毒症的患者发生急性呼吸衰竭的风险很高： 50%需要机械通气。脓毒症合并肺损伤和呼吸衰竭的患者中， 没有呼吸衰竭的人的死亡率是没有呼吸衰竭的人的两倍，但人们对如何预防这一重要疾病知之甚少。 医院获得性败血症并发症指南建议所有患者在一小时内开始使用抗生素 脓毒症患者，但这些建议主要依赖于社区获得性 脓毒症，一个已知在特征、风险和结局方面与医院获得性败血症患者不同的人群， 败血症此外，医院获得性脓毒症患者在脓毒症护理方面有充分记录的延迟， 很少能达到抗生素使用时间的质量目标。在决定因素方面存在重大知识差距 以及医院获得性败血症患者抗生素使用时机的影响，限制了我们预防败血症的能力。 急性呼吸衰竭和其他不良后果的发展，在这个高风险的人群。的目标 本研究的目的是确定与抗生素使用时间相关的患者临床表现的特征 在医院获得性脓毒症中，并评估抗生素时机在降低呼吸道感染风险中的作用。 失败首先，我们对约1,800例医院获得性脓毒症住院患者进行回顾性队列研究， 将检测脓毒症发作时患者水平的临床因素与开始使用抗生素时间的相关性。 第二，我们将测试抗生素使用时机与急性呼吸衰竭发生的关系， 应用回归和工具变量方法。该项目得到了姑息疗法的支持， 宾夕法尼亚大学高级疾病研究中心（PAIR），该中心拥有出色的跟踪 在培训中支持和促进卫生服务研究人员的职业生涯的记录。候选人将 由一个在急性呼吸衰竭、败血症、资源紧张方面具有专业知识的团队进行密集指导， 因果推理方法通过该项目进行的体验式培训将辅之以以下课程： 应用回归分析和事件发生时间分析。这项工作的结果将直接告知发展 申请K23指导职业发展奖，旨在确定重要的败血症临床 亚组，以提高脓毒症护理的及时性和我们预防呼吸道疾病进展的能力。 失败