抗生素给药时机及感染灶控制对成人手术重症脓毒症患者预后的影响

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-06-05 DOI:10.1016/j.jemermed.2025.05.019

Pedro M. Garrido Benedicto , Pitter F. Cueto Quintana , Juan Antonio Brito Piris , Elisabet Garcia Mañosa , Karla Malpica Basurto , Raquel Enriquez Sanchez , Immaculada Vallverdú Perapoch , Jordi Camps Andreu

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引用次数: 0

摘要

背景：延迟使用抗生素和手术控制感染源与脓毒症患者死亡率增加有关。目的本研究的主要目的是评估延迟首次使用抗生素剂量和手术控制感染源时机对住院死亡率的影响。方法本研究为单中心、回顾性观察性研究，纳入医院急诊科收治的155例重症脓毒症患者。所有患者在进入重症监护病房（ICU）前均接受了感染源手术控制。结果首次给药时间中位数为5.6 h (IQR: 2.5 ~ 10.8)，手术时间中位数为11.3 h （IQR: 6.7 ~ 21.8）。只有28%的患者在ED到达后的前3小时内接受了抗生素治疗，23.2%的患者在ED到达后的前6小时内接受了手术。在3小时内与之后接受抗生素治疗的患者（25.0%对15.3%,p = 0.158）、有无感染性休克的患者（50.0%对43.3%,p = 0.519）或基于手术时间的患者（p = 0.085）的死亡率无显著差异。老年患者死亡率较高（p = 0.036）。多变量分析显示，只有患者年龄、慢性肾脏疾病（CKD）和到达医院后手术时间少于6小时与死亡率独立相关。发现延迟给予第一次抗生素剂量与延迟手术之间有很强的相关性(p <；0.0001)。结论在我们的研究中，需要控制感染病灶的脓毒症患者不能从早期给药和快速手术干预中获益。年龄越大，死亡率越高。此外，抗生素给药的延迟与手术干预的延迟密切相关，强调了简化败血症管理方案的必要性。

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Influence of the Timing of Antibiotic Administration and Control of Infectious Foci on the Prognosis of Adult Patients with Critical Surgical Sepsis

Background

Delay in administration of antibiotics and surgical control of the infection source are linked to increased mortality in septic patients.

Objective

The primary objective was to assess the impact of delays in administering the first antibiotic dose and the timing of surgical control of the infection source on in-hospital mortality.

Method

This single-center, retrospective observational study included 155 critically ill septic patients admitted to hospital emergency department (ED). All patients underwent surgical control of the infection source before admission to the intensive care unit (ICU).

Results

The median time to the first antibiotic dose was 5.6 hours (IQR: 2.5–10.8) and the median time to surgery was 11.3 hours (IQR: 6.7–21.8). Only 28% of patients received antibiotic therapy within the first 3 hours, and 23.2% underwent surgery within the first 6 hours after ED arrival. Mortality rates did not differ significantly between patients who received antibiotics within 3 hours vs. later (25.0% vs. 15.3%, p = 0.158), those with or without septic shock (50.0% vs. 43.3%, p = 0.519), or based on surgical timing (p = 0.085). Older patients exhibited higher mortality (p = 0.036). Multivariate analysis revealed that only patient age, chronic kidney disease (CKD), and a time to surgery of less than 6 hours from hospital arrival were independently associated with mortality. A strong correlation was found between delays in administering the first antibiotic dose and delays in surgery (p < 0.0001).

Conclusion

In our series, septic patients requiring control of the infectious focus did not benefit from the combination of early antibiotic administration and faster surgical intervention. Older age was associated with higher mortality. Additionally, delays in antibiotic administration were strongly correlated with delays in surgical intervention, highlighting the need for streamlined sepsis management protocols.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine