Adam Green, Sharad Patel, Pamela Crabtree, Divyesha Patel, Andrew Hoke, Ricardo Jaime Orozco, George Sangah, Alvin Mercado, Nicole Melchiorre, Mariane Charron, Abhimanyu Chandel, Nitin Puri
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引用次数: 0
Abstract
Background: The efficacy of the SEP-1 Bundle has been questioned in the treatment of patients with hospital-acquired sepsis. We aimed to investigate bundle compliance and its association with survival in a subset of patients with HA sepsis: those with ICU-acquired sepsis.
Methods: A single-center retrospective cohort study was conducted in a tertiary care referral hospital. Adult patients diagnosed with ICU-acquired sepsis between 1 January 2019 and 31 December 2022 were identified. Survival to hospital discharge adjusted for disease severity based on 3-hour, 6-hour, and total bundle compliance was calculated. Secondary outcomes included the need for mechanical ventilation, vasopressors, initiation of acute hemodialysis, and discharge location.
Results: Of 191 patients with ICU-acquired sepsis, 61 patients (31.9%) demonstrated total bundle compliance. There was no difference in survival based on the unadjusted analysis of 3-hour bundle compliance, compliant versus non-compliant (78.9% vs. 67.0%; P = 0.100). However, there was a survival benefit in 6-hour and total bundle, compliance versus non-compliance (82.2% vs. 60.0%, P < 0.001; 86.9% vs. 64.6%, P = 0.002). When adjusted for SOFA and CCI, logistic regression demonstrated similar results: 3-hour compliance (OR: 0.60; 95% CI: 0.29-1.18, P = 0.150), 6-hour compliance (OR: 0.35; 95% CI: 0.17-0.68, P = 0.002) and total compliance (OR: 0.31; 95% CI: 0.13-0.69, P = 0.006). Components of the SEP-1 Bundle that showed a mortality benefit included the collection of "blood cultures prior to antibiotic administration" (OR: 0.46; 95% CI 0.22-0.96, P = 0.037) and "tissue perfusion assessment" (OR: 0.41; 95% CI 0.18-0.90, P = 0.028).
Conclusions: Six-hour and total SEP-1 bundle compliance was associated with increased hospital survival in patients with ICU-acquired sepsis. These findings suggest the importance of sepsis bundle compliance in the ICU environment.
背景：SEP-1 Bundle在治疗医院获得性脓毒症患者中的疗效一直受到质疑。我们的目的是调查束依从性及其与HA脓毒症患者生存率的关系：icu获得性脓毒症患者。方法：在某三级转诊医院进行单中心回顾性队列研究。确定了2019年1月1日至2022年12月31日期间诊断为重症监护病房获得性败血症的成年患者。根据疾病严重程度调整3小时、6小时和总束依从性，计算到出院的生存率。次要结局包括需要机械通气、血管加压药、开始急性血液透析和出院地点。结果：191例icu获得性败血症患者中，61例患者（31.9%）表现出完全依从性。基于未经调整的3小时束依从性分析，依从性与不依从性的生存率无差异(78.9% vs 67.0%；p = 0.100)。然而，在6小时和总束中，依从性与不依从性（82.2% vs. 60.0%， P）存在生存获益。结论：6小时和总SEP-1束依从性与icu获得性败血症患者的住院生存率增加相关。这些发现提示了脓毒症bundle依从性在ICU环境中的重要性。临床试验号：不适用。
期刊介绍：
BMC Infectious Diseases is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology.
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