抗生素给药时间与老年败血症患者的短期和长期预后之间的关系
Yuhui Pan1, Yanyan Ma1, Ke Wan1
1Department of Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100032, China.
Journal of intensive care medicine
|October 22, 2025
概括
早期的抗生素可以改善老年败血症患者的生存率,特别是那些没有败血症休克或患有格拉姆阳性感染的人. 延迟使用抗生素显著增加了这种脆弱人群的死亡风险.
科学领域:
- 关键护理医学 关键护理医学
- 老年医学 老年医学
- 传染性疾病 传染性疾病
背景情况:
- 由于生理变化和并发症,老年人感染败血症的管理是复杂的.
- 在老年败血症患者中,给予抗生素的最佳时间仍在争论中.
- 这项研究解决了澄清抗生素时间对老年人结果的影响的关键需求.
研究的目的:
- 评估老年败血症患者的抗生素服用时间和短期和长期结果之间的关联.
- 调查休克状态和病原体类型如何改变这种关联.
- 为老年人群中败血症管理提供基于证据的建议.
主要方法:
- 使用MIMIC-IV数据库 (v3.1) 的回顾性队列研究 (v3.1).
- 分类为早期 (<1小时) 和晚期 (>1小时) 抗生素给药组.
- 多变量考克斯回归和受限立方脊柱模型用于评估死亡风险和剂量反应关系,按冲击和病原体类型分层.
主要成果:
- 延迟使用抗生素与28天死亡风险增加35% (HR=1.35),180天死亡风险增加43% (HR=1.43),365天死亡风险增加45% (HR=1.45).
- 早期抗生素对死亡率的好处在非休克患者和患有格拉姆阳性感染的患者中显著.
- 没有发现延迟抗生素和死亡率在败血性休克或格兰氏阴性感染之间有显著的关联.
结论:
- 早期服用抗生素对于改善老年败血症患者的生存率至关重要.
- 这些益处在非冲击病例和格拉姆阳性感染中最为明显.
- 临床实践应考虑个性化的患者环境,以实现最佳的败血症管理.
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