METHODS: We studied 446 admissions after introduction of an ECIL-4-based protocol (hereafter \"ECIL-4 group\") in comparison to a historic cohort of 512 admissions. Primary clinical endpoints were the incidence of infectious complications including septic shock, infection-related intensive care unit (ICU) admission, and overall mortality. Secondary endpoints included the incidence of recurrent fever, bacteremia, and antibiotic consumption.
RESULTS: Bacteremia occurred more frequently in the ECIL-4 group (46.9% [209/446] vs 30.5% [156/512]; P < .001), without an associated increase in septic shock (4.7% [21/446] vs 4.5% [23/512]; P = .878) or infection-related ICU admission (4.9% [22/446] vs 4.1% [21/512]; P = .424). Overall mortality was significantly lower in the ECIL-4 group (0.7% [3/446] vs 2.7% [14/512]; P = .016), resulting mainly from a decrease in infection-related mortality (0.4% [2/446] vs 1.8% [9/512]; P = .058). Antibiotic consumption was significantly reduced by a median of 2 days on antibiotic therapy (12 vs 14; P = .001) and 7 daily antibiotic doses (17 vs 24; P < .001) per admission period.
CONCLUSIONS: Our results support implementation of ECIL-4 recommendations to be both safe and effective based on real-world data in a large high-risk patient population. We found no increase in infectious complications and total antibiotic exposure was significantly reduced.
方法:我们在引入基于ECIL-4的方案(以下简称“ECIL-4组”)后研究了446例入院,并与512例入院的历史队列进行了比较。主要临床终点是感染性并发症的发生率,包括感染性休克,感染相关重症监护病房(ICU)入院,和总死亡率。次要终点包括反复发热的发生率,菌血症,和抗生素消费。
结果:在ECIL-4组中,菌血症的发生率更高(46.9%[209/446]vs30.5%[156/512];P<.001),感染性休克(4.7%[21/446]vs4.5%[23/512];P=.878)或感染相关ICU入院(4.9%[22/446]vs4.1%[21/512];P=.424)无相关增加。ECIL-4组的总死亡率显着降低(0.7%[3/446]比2.7%[14/512];P=.016),主要是由于感染相关死亡率下降(0.4%[2/446]vs1.8%[9/512];P=.058)。每次入院期间,抗生素治疗的平均2天(12vs14;P=.001)和7日抗生素剂量(17vs24;P<.001)的抗生素消耗量显着减少。
结论:我们的结果支持ECIL-4建议的实施是安全和有效的,基于现实世界的数据在一个大的高风险患者群体。我们发现感染并发症没有增加,总的抗生素暴露量显著减少。