更新的生存性败血症运动的现实世界影响 抗生素推时间推
Stephanie P Taylor1, Marc A Kowalkowski2, Sable Skewes3
1Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI.
更新的生存性败血症运动 (SSC) 对抗生素时间的指导方针得到了现实世界的数据的支持. 临床医生不需要遵守严格的1小时目标,对于可能有败血症和没有休克的患者.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 医疗保健服务研究 医疗服务研究
背景情况:
- 活下来的败血症运动 (SSC) 更新了关于治疗败血症的抗生素时间的建议.
- 更新的指南采用了风险和概率分层的方法,远离所有疑似感染的普遍1小时目标.
研究的目的:
- 评估更新的SSC建议对抗生素施用时间的现实影响.
- 评估风险和概率分层对大型患者队列中的抗生素时间的影响.
主要方法:
- 从2017年到2021年,美国东南部12家医院的166,559名成年患者参与了回顾性队列研究.
- 利用0.5的切割值的感染预测模型将患者分为以下类别:休克缺席/存在和可能/可能感染.
- 分析了基于这些分类的抗生素给药时间和住院死亡率.
主要成果:
- 30%的疑似感染患者被归类为没有冲击,可能感染,有资格接受3小时的抗生素推,抗生素的中位时间为5.5小时,死亡率为2%.
- 没有休克,可能感染的患者在平均3.2小时内接受了抗生素,死亡率为3%.
- 患有冲击现象,可能感染的患者平均在2.7小时内接受抗生素,死亡率为17%.
- 患有休克,可能感染的患者在平均6.9小时内接受了抗生素,死亡率为12%.
结论:
- 这些发现支持最新的SSC建议,证明了风险和概率分层抗生素定时的可行性.
- 经验证据表明,对于可能没有冲击的败血症患者,不需要1小时的抗生素标.
- 这些结果支持基于患者风险分层的定制抗生素定时策略.
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