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Am J Resp Crit Care:脓毒症早期抗生素治疗时机与住院死亡率有啥关系?

2017-03-28 xing.T MedSci原创

在一个大型的、当代多中心的急诊科脓毒症患者的样本中,抗生素使用延误与住院死亡率的几率增加有关,即使在所有6小时内接受抗生素治疗的患者中。在感染性休克患者中脓毒症严重程度增加和死亡率增加的可能性最大。

以往评估脓毒症患者抗生素的使用时机的研究已经得出了不一致的结果。近日,呼吸内科以及重症医学领域权威杂志Am J Resp Crit Care上发表了一篇研究文章,研究人员旨在通过在急诊科就诊后6小时内使用抗生素的脓毒症患者来评价抗生素时机与患者病死率之间的相关性。

研究人员回顾性地研究了加利福尼亚北部21个急诊科在2010年至2013年期间接受治疗的35000例随机选择的脓毒症住院患者。该研究的主要暴露为急诊科就诊后6小时内给予抗生素治疗。该研究的主要结局为调整后的住院死亡率。在入院1小时内研究人员使用详细的生理数据来量化疾病的严重程度,并采用logistic回归估计基于抗生素使用时机和病人因素的住院死亡几率。

抗生素治疗的中位时间为2.1个小时(四分位间距范围为1.4-3.1小时)。住院后抗生素使用每延迟一小时的调整后住院死亡率比值比为1.09(95%可信区间为1.05-1.13)。绝对死亡率的增加与抗生素使用的延迟小时相关:对于脓毒症患者为0.3%(95%可信区间为0.01%-0.6%;P=0.04),对于严重脓毒症患者为0.4%(95%可信区间为0.1%-0.8%;P=0.02),对于休克的患者为1.8%(95%可信区间为0.8%-3.0%;P=0.001)。

在一个大型的、当代多中心的急诊科脓毒症患者的样本中,抗生素使用延误与住院死亡率的几率增加有关,即使在所有6小时内接受抗生素治疗的患者中。在感染性休克患者中脓毒症严重程度增加和死亡率增加的可能性最大。

原始出处:

Vincent X Liu, et al. The Timing of Early Antibiotics and Hospital Mortality in Sepsis. AM J RESP CRIT CARE 2017. http://dx.doi.org/10.1164/rccm.201609-1848OC

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    唱个歌红红火火恍恍惚惚

    0

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    2017-04-01 为你把脉

    vv个红红火火恍恍惚惚好

    0

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    2017-03-31 为你把脉

    吃吃吃吃个饭古古怪怪

    0

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    2017-03-30 为你把脉

    唱唱歌刚刚古古怪怪嘎嘎嘎

    0

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    2017-03-30 半夏微凉

    学习了谢谢!

    0

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    2017-03-30 sunlong28

    0

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