Objectives

To evaluate the effect of timing and appropriateness of antibiotics administration on mortality in patients diagnosed with sepsis according to the Sepsis-3 definition.

Methods

This prospective cohort study was conducted in patients diagnosed with sepsis according to the Sepsis-3 definition at the emergency department of Korea University Ansan Hospital from January 2016 to January 2019. The time to antibiotics was defined as the time in hours from emergency department arrival to the first antibiotic administration. Cox proportional hazards regression analysis was used to estimate the association between time to antibiotics and 7-, 14- and 28-day mortality.

Results

Of 482 patients enrolled onto this study, 203 (42.1%) of 482 and 312 (64.7%) of 482 were diagnosed with septic shock and high-grade infection respectively. The median time to receipt of antibiotic therapy was 115 minutes. Antibiotics were administered within 3 and 6 hours in 340 (70.4%) of 482 and 450 (93.2%) of 482 patients respectively. Initial appropriate empirical antibiotics were administered in 375 (77.8%) of 482 patients. The time to and appropriateness of the initial antibiotics were not associated with 7-, 14- and 28-day mortality in multivariate analysis. The Sequential Organ Failure Assessment (SOFA) score (adjusted hazard ratio (aHR) 1.229, 95% confidence interval (CI) 1.093–1.381, p 0.001) and initial lactate levels (aHR 1.128, 95% CI 1.034–1.230, p 0.007), Charlson comorbidity index (aHR 1.115, 95% CI 1.027–1.210, p 0.014), 2-hour lactate level (aHR 1.115, 95% CI 1.027–1.210, p 0.009) and SOFA score (aHR 1.077, 95% CI 1.013–1.144, p 0.018) affected 7-, 14- and 28-day mortality respectively. Subgroup analysis with septic shock, bacteraemia and high-grade infection did not affect mortality rates.

Conclusions

Time to receipt of antibiotics may not affect the prognosis of patients with sepsis if a rapid and well-trained resuscitation is combined with appropriate antibiotic administration within a reasonable time.

中文翻译：

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败血症患者的抗生素时机：一项前瞻性队列研究。

目标

根据Sepsis-3定义，评估抗生素施用时机和适当性对诊断为败血症的患者死亡率的影响。

方法

这项前瞻性队列研究是根据2016年1月至2019年1月在高丽大学安山医院急诊室根据脓毒症-3定义诊断为脓毒症的患者中进行的。抗生素使用时间定义为从急诊科到达医院到到达医院的小时数。首次使用抗生素。使用Cox比例风险回归分析来估计抗生素使用时间与7天，14天和28天死亡率之间的关联。

结果

在该研究的482名患者中，分别有482名患者中的203名（42.1％）和482名患者中的312名（64.7％）被诊断为败血性休克和严重感染。接受抗生素治疗的中位时间为115分钟。分别在482名患者的340（70.4％）和450（93.2％）的3和6小时内施用了抗生素。在482例患者中，有375例（77.8％）使用了最初适当的经验性抗生素。在多变量分析中，最初使用抗生素的时间和适当性与7天，14天和28天的死亡率无关。序贯器官衰竭评估（SOFA）评分（调整后的危险比（aHR）1.229，95％置信区间（CI）1.093–1.381，p 0.001）和初始乳酸水平（aHR 1.128，95％CI 1.034–1.230，p 0.007） ，查尔森合并症指数（aHR 1.115，95％CI 1.027-1.210，p 0.014），2小时的乳酸水平（aHR 1.115，95％CI 1.027-1.210，p 0.009）和SOFA评分（aHR 1.077，95％CI 1.013-1.144，p 0.018）分别影响7天，14天和28天的死亡率。败血性休克，菌血症和严重感染的亚组分析不影响死亡率。

结论

如果在合理的时间内进行快速且训练有素的复苏与适当的抗生素管理相结合，则接受抗生素的时间可能不会影响败血症患者的预后。