Background

Rapid initiation of antibiotic treatment is considered crucial in patients with severe infections such as septic shock and bacterial meningitis, but may not be as important for other infectious syndromes. A better understanding of which patients can tolerate a delay in start of therapy is important for antibiotic stewardship purposes.

Objectives

To explore the existing evidence on the impact of time to antibiotics on clinical outcomes in patients presenting to the emergency department (ED) with bacterial infections of different severity of illness and source of infection.

Sources

A literature search was performed in the PubMed/MEDLINE database using combined search terms for various infectious syndromes (sepsis/septic shock, bacterial meningitis, lower respiratory tract infections, urinary tract infections, intra-abdominal infections and skin and soft tissue infections), time to antibiotic treatment, and clinical outcome.

Content

The literature search generated 8828 hits. After screening titles and abstracts and assessing potentially relevant full-text papers, 60 original articles (four randomized controlled trials, 43 observational studies) were included. Most articles addressed sepsis/septic shock, while few studies evaluated early initiation of therapy in mild to moderate disease. The lack of randomized trials and the risk of confounding factors and biases in observational studies warrant caution in the interpretation of results. We conclude that the literature supports prompt administration of effective antibiotics for septic shock and bacterial meningitis, but there is no clear evidence showing that a delayed start of therapy is associated with worse outcome for less severe infectious syndromes.

Implications

For patients presenting with suspected bacterial infections, withholding antibiotic therapy until diagnostic results are available and a diagnosis has been established (e.g. by 4–8 h) seems acceptable in most cases unless septic shock or bacterial meningitis are suspected. This approach promotes the use of ecologically favourable antibiotics in the ED, reducing the risks of side effects and selection of resistance.

中文翻译：

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急诊科接受抗生素治疗的时间对细菌感染患者临床结局的影响：对抗菌素管理的影响

背景

对于患有严重感染（如脓毒性休克和细菌性脑膜炎）的患者，快速开始抗生素治疗被认为是至关重要的，但对于其他传染性综合征可能并不那么重要。更好地了解哪些患者可以耐受开始治疗的时间对于抗生素管理很重要。

目标

探讨存在时间的抗生素对急诊科（ED）出现不同疾病严重程度和感染源的细菌感染患者的临床效果的影响。

资料来源

在PubMed / MEDLINE数据库中使用各种传染性综合征（败血症/败血性休克，细菌性脑膜炎，下呼吸道感染，泌尿道感染，腹腔内感染以及皮肤和软组织感染）的组合搜索词进行文献检索进行抗生素治疗，并取得临床效果。

内容

文献搜索产生了8828个命中。在筛选标题和摘要并评估可能相关的全文后，纳入了60篇原创文章（四项随机对照试验，43项观察性研究）。大多数文章涉及败血症/败血性休克，而很少有研究评估轻度至中度疾病的早期治疗。观察研究中缺乏随机试验以及混杂因素和偏倚的风险，在解释结果时应谨慎行事。我们得出的结论是，文献支持对败血性休克和细菌性脑膜炎及时使用有效的抗生素，但尚无明确证据表明治疗延误与较不严重的感染综合征的预后差有关。

含义

对于表现出疑似细菌感染的患者，除非怀疑有败血性休克或细菌性脑膜炎，否则在大多数情况下都应接受抗生素治疗直至获得诊断结果并确定诊断（例如4至8小时）。这种方法促进在急诊室中使用生态上有利的抗生素，从而减少了副作用和选择耐药性的风险。