PDF(Pubmed)
Abstract：
Bacteraemia is a critical condition that generally leads to substantial morbidity and mortality. It is unclear whether delayed antimicrobial therapy (and/or source control) has a prognostic or defervescence effect on patients with source-control-required (ScR) or unrequired (ScU) bacteraemia.
The multicenter cohort included treatment-naïve adults with bacteraemia in the emergency department. Clinical information was retrospectively obtained and etiologic pathogens were prospectively restored to accurately determine the time-to-appropriate antibiotic (TtAa). The association between TtAa or time-to-source control (TtSc, for ScR bacteraemia) and 30-day crude mortality or delayed defervescence were respectively studied by adjusting independent determinants of mortality or delayed defervescence, recognised by a logistic regression model.
Of the total 5477 patients, each hour of TtAa delay was associated with an average increase of 0.2% (adjusted odds ratio [AOR], 1.002; P < 0.001) and 0.3% (AOR 1.003; P < 0.001) in mortality rates for patients having ScU (3953 patients) and ScR (1524) bacteraemia, respectively. Notably, these AORs were augmented to 0.4% and 0.5% for critically ill individuals. For patients experiencing ScR bacteraemia, each hour of TtSc delay was significantly associated with an average increase of 0.31% and 0.33% in mortality rates for overall and critically ill individuals, respectively. For febrile patients, each additional hour of TtAa was significantly associated with an average 0.2% and 0.3% increase in the proportion of delayed defervescence for ScU (3085 patients) and ScR (1266) bacteraemia, respectively, and 0.5% and 0.9% for critically ill individuals. For 1266 febrile patients with ScR bacteraemia, each hour of TtSc delay respectively was significantly associated with an average increase of 0.3% and 0.4% in mortality rates for the overall population and those with critical illness.
Regardless of the need for source control in cases of bacteraemia, there seems to be a significant association between the prompt administration of appropriate antimicrobials and both a favourable prognosis and rapid defervescence, particularly among critically ill patients. For ScR bacteraemia, delayed source control has been identified as a determinant of unfavourable prognosis and delayed defervescence. Moreover, this association with patient survival and the speed of defervescence appears to be augmented among critically ill patients.
The multicenter cohort included treatment-naïve adults with bacteraemia in the emergency department. Clinical information was retrospectively obtained and etiologic pathogens were prospectively restored to accurately determine the time-to-appropriate antibiotic (TtAa). The association between TtAa or time-to-source control (TtSc, for ScR bacteraemia) and 30-day crude mortality or delayed defervescence were respectively studied by adjusting independent determinants of mortality or delayed defervescence, recognised by a logistic regression model.
Of the total 5477 patients, each hour of TtAa delay was associated with an average increase of 0.2% (adjusted odds ratio [AOR], 1.002; P < 0.001) and 0.3% (AOR 1.003; P < 0.001) in mortality rates for patients having ScU (3953 patients) and ScR (1524) bacteraemia, respectively. Notably, these AORs were augmented to 0.4% and 0.5% for critically ill individuals. For patients experiencing ScR bacteraemia, each hour of TtSc delay was significantly associated with an average increase of 0.31% and 0.33% in mortality rates for overall and critically ill individuals, respectively. For febrile patients, each additional hour of TtAa was significantly associated with an average 0.2% and 0.3% increase in the proportion of delayed defervescence for ScU (3085 patients) and ScR (1266) bacteraemia, respectively, and 0.5% and 0.9% for critically ill individuals. For 1266 febrile patients with ScR bacteraemia, each hour of TtSc delay respectively was significantly associated with an average increase of 0.3% and 0.4% in mortality rates for the overall population and those with critical illness.
Regardless of the need for source control in cases of bacteraemia, there seems to be a significant association between the prompt administration of appropriate antimicrobials and both a favourable prognosis and rapid defervescence, particularly among critically ill patients. For ScR bacteraemia, delayed source control has been identified as a determinant of unfavourable prognosis and delayed defervescence. Moreover, this association with patient survival and the speed of defervescence appears to be augmented among critically ill patients.
摘要：
背景：菌血症是一种危重症，通常会导致大量的发病率和死亡率。目前尚不清楚延迟的抗菌治疗（和/或来源控制）对需要来源控制（ScR）或不需要（ScU）菌血症的患者是否具有预后或退热作用。
方法：多中心队列包括急诊科未治疗的细菌血症成人。回顾性获得临床信息，并前瞻性恢复病原体，以准确确定合适的抗生素（TtAa）时间。TtAa或时间到源控制(TtSc，通过调整死亡率或延迟退热的独立决定因素，分别研究了ScR菌血症）和30天的粗死亡率或延迟退热，由逻辑回归模型识别。
结果：在总共5477名患者中，TtAa延迟的每小时平均增加0.2%(调整后的比值比[AOR]，患有ScU（3953名患者）和ScR（1524）菌血症的患者的死亡率为1.002;P<0.001）和0.3％（AOR1.003;P<0.001），分别。值得注意的是,对于危重患者,这些AOR分别增加到0.4%和0.5%.对于患有ScR菌血症的患者，每小时的TtSc延迟与总体和危重患者的死亡率平均增加0.31％和0.33％显着相关，分别。对于发热患者，TtAa的每一小时与ScU（3085例）和ScR（1266例）菌血症的延迟退热比例平均增加0.2％和0.3％显着相关，分别,危重病人分别为0.5%和0.9%。对于1266例发热的ScR菌血症患者，每小时TtSc延迟分别与总人口和危重病患者死亡率平均增加0.3%和0.4%显著相关.
结论：无论菌血症病例是否需要进行源头控制，迅速给予适当的抗菌药物与良好的预后和快速退热之间似乎存在显着关联，尤其是危重病人。对于ScR菌血症，延迟源控制已被确定为不良预后和延迟退热的决定因素。此外，在危重患者中,这种与患者生存和退热速度的关联似乎增强.
方法：多中心队列包括急诊科未治疗的细菌血症成人。回顾性获得临床信息，并前瞻性恢复病原体，以准确确定合适的抗生素（TtAa）时间。TtAa或时间到源控制(TtSc，通过调整死亡率或延迟退热的独立决定因素，分别研究了ScR菌血症）和30天的粗死亡率或延迟退热，由逻辑回归模型识别。
结果：在总共5477名患者中，TtAa延迟的每小时平均增加0.2%(调整后的比值比[AOR]，患有ScU（3953名患者）和ScR（1524）菌血症的患者的死亡率为1.002;P<0.001）和0.3％（AOR1.003;P<0.001），分别。值得注意的是,对于危重患者,这些AOR分别增加到0.4%和0.5%.对于患有ScR菌血症的患者，每小时的TtSc延迟与总体和危重患者的死亡率平均增加0.31％和0.33％显着相关，分别。对于发热患者，TtAa的每一小时与ScU（3085例）和ScR（1266例）菌血症的延迟退热比例平均增加0.2％和0.3％显着相关，分别,危重病人分别为0.5%和0.9%。对于1266例发热的ScR菌血症患者，每小时TtSc延迟分别与总人口和危重病患者死亡率平均增加0.3%和0.4%显著相关.
结论：无论菌血症病例是否需要进行源头控制，迅速给予适当的抗菌药物与良好的预后和快速退热之间似乎存在显着关联，尤其是危重病人。对于ScR菌血症，延迟源控制已被确定为不良预后和延迟退热的决定因素。此外，在危重患者中,这种与患者生存和退热速度的关联似乎增强.
