推迟适当的抗微生物治疗对患有金黄色葡萄球菌血感染的儿童的影响
Ziyao Guo1, Ximing Xu2, Guangli Zhang1,3
1National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
European journal of pediatrics
|June 14, 2024
概括
早期适当的抗微生物治疗黄金葡萄球菌血流感染 (SAB) 是至关重要的. 治疗延迟6.4小时可能会增加儿童的败血症和败血症休克风险,尽管住院死亡率仍然相似.
科学领域:
- 儿童传染病 儿童传染病
- 抗微生物药物管理委员会
- 临床结果研究研究
背景情况:
- 黄金葡萄球菌血流感染 (SAB) 是一个重要的儿科问题,早期的抗菌药物治疗至关重要.
- 在儿科SAB中启动适当的抗微生物治疗的最佳时间仍未确定,平衡疗效与抗微生物耐药性的担忧.
- 确定这种最佳时间窗口对于有效的治疗策略和预防不良结果至关重要.
研究的目的:
- 确定适用于小儿SAB的适当抗菌疗法的最佳时间窗口.
- 评估延迟适当的抗微生物治疗对不良临床结果的影响,包括住院死亡率,败血症和败血性休克.
- 利用倾向性得分匹配 (PSM) 来控制分析治疗延迟效应的混因素.
主要方法:
- 对247名患有SAB的儿科患者进行了回顾性分析.
- 接收器运行特征 (ROC) 分析以确定最佳时间到适当治疗 (TTAT) 截止值 (确定为6.4小时).
- 倾向分数匹配 (PSM) 创建可比的及时 (TTAT <6.4h) 和延迟 (TTAT ≥6.4h) 治疗组; Kaplan-Meier 和 Cox 回归分析被应用到匹配的数据中.
主要成果:
- 最佳的TTAT切线被确定为6.4小时 (AUC0.803).
- 不匹配的分析显示,延迟治疗组的死亡率,败血症和败血症休克显著增加.
- 在PSM (134次) 后,延迟治疗 (≥6.4小时) 与 significantly更高的败血症 (HR 2.512) 和败血症休克 (HR 3.109) 的发生率有关,但不是住院死亡率.
结论:
- 对于儿科SAB的适当抗菌疗法延迟6.4小时可能会增加发生败血症和败血性休克的风险.
- 住院死亡率似乎没有受到6.4小时延迟适当治疗的显著影响.
- 这项研究强调了在儿科SAB中及时使用抗微生物药物的重要性,以减轻严重并发症,并使用PSM进行可靠的分析.
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