セプシスまたはセプティックショック患者の抗生物質投与開始の適切なタイミング: 系統的レビューとメタ解析
Nam Su Ku1, Yongseop Lee1, Dae Won Park2
1Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
The Korean journal of internal medicine
|August 27, 2025
まとめ
セプシス患者では3時間以内に,そしてセプシスショック患者では1時間以内に,抗生物質の迅速な投与は,死亡率を低減するために極めて重要です. 早期治療は,これらの重大な状態における生存率に大きな影響を及ぼします.
科学分野:
- クリティカル ケア 医療
- 感染症
- 臨床薬理学
背景:
- セプシスおよびセプティックショックにおける抗生物質投与の最適なタイミングは,患者の管理における重要な問題です.
- ショックなしでの早期抗生物質使用の証拠は限られており,さらなる調査が必要である.
研究 の 目的:
- セプシスとセプティックショック患者の死亡率に対する抗生物質投与開始タイミングの影響を決定するために,既存の研究を体系的にレビューし,メタ分析する.
主な方法:
- 2022年11月までの主要データベース (PubMed,EMBASE,Cochrane,KMD) で,包括的な体系的な文献検索が行われました.
- キーワードには"セプシス""セプシスショック""抗菌剤""治療までの時間""時間要因"が含まれています
- 79,246人の患者を対象とした13件のデータを分析した.
主要な成果:
- セプシスの全症例では,抗生物質が3時間以内に投与された場合に死亡率が有意に低下したが,遅延した治療と比較して1時間以内に必要ではなかった.
- セプティックショックを受けた患者では,治療を遅らせた患者と比較して,抗生物質を1時間または3時間以内に投与したグループでは死亡率が著しく低下しました.
- 特に,診断後1時間以内に抗生物質を投与すると,結血性ショック患者の死亡率が低下した.
結論:
- 早期に抗生物質を投与することは,敗血症と結血病ショックの改善に不可欠です.
- セプティックショックの場合,1時間以内に抗生物質を投与すると死亡率が低下します.
- ショックのない症では,抗生物質投与の3時間の窓は死亡率を減らすのに有益である.
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