ASSOCIATION OF DELAYED ANTIMICROBIAL THERAPY WITH ONE-YEAR MORTALITY IN PEDIATRIC SEPSIS

被引:26
作者
Han, Moonjoo [1 ]
Fitzgerald, Julie C. [1 ]
Balamuth, Fran [2 ]
Keele, Luke [3 ,4 ]
Alpern, Elizabeth R. [5 ]
Lavelle, Jane [2 ]
Chilutti, Marianne [6 ]
Grundmeier, Robert W. [6 ,7 ]
Nadkarni, Vinay M. [1 ]
Thomas, Neal J. [8 ]
Weiss, Scott L. [1 ]
机构
[1] Univ Penn, Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care, Div Crit Care Med,Perelman Sch Med, Philadelphia, PA 19104 USA
[2] Univ Penn, Childrens Hosp Philadelphia, Dept Pediat, Div Emergency Med,Perelman Sch Med, Philadelphia, PA 19104 USA
[3] Georgetown Univ, McCourt Sch Publ Policy, Washington, DC USA
[4] Georgetown Univ, Dept Govt, Washington, DC USA
[5] Northwestern Univ, Dept Pediat, Lurie Childrens Hosp Chicago, Div Emergency Med,Feinberg Sch Med, Chicago, IL 60611 USA
[6] Childrens Hosp Philadelphia, Dept Biomed & Hlth Informat, Philadelphia, PA 19104 USA
[7] Univ Penn, Childrens Hosp Philadelphia, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USA
[8] Penn State Univ, Coll Med, Penn State Hershey Childrens Hosp, Div Pediat Crit Care Med, Hershey, PA USA
来源
SHOCK | 2017年 / 48卷 / 01期
关键词
Critically ill children; long-term mortality; timing; GOAL-DIRECTED THERAPY; SEPTIC SHOCK; ANTIBIOTIC-TREATMENT; INCREASES MORTALITY; EPIDEMIOLOGY; DETERMINANT; SURVIVAL; DURATION; OUTCOMES; IMPACT;
D O I
10.1097/SHK.0000000000000833
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: Delayed antimicrobial therapy in sepsis is associated with increased hospital mortality, but the impact of antimicrobial timing on long-term outcomes is unknown. We tested the hypothesis that hourly delays to antimicrobial therapy are associated with 1-year mortality in pediatric severe sepsis. Design: Retrospective observational study. Setting: Quaternary academic pediatric intensive care unit (PICU) from February 1, 2012 to June 30, 2013. Patients: One hundred sixty patients aged <= 21 years treated for severe sepsis. Interventions: None. Measurements and Main Results: We tested the association of hourly delays from sepsis recognition to antimicrobial administration with 1-year mortality using multivariable Cox and logistic regression. Overall 1-year mortality was 24% (39 patients), of whom 46% died after index PICU discharge. Median time from sepsis recognition to antimicrobial therapy was 137 min (IQR 65-287). After adjusting for severity of illness and comorbid conditions, hourly delays up to 3 h were not associated with 1-year mortality. However, increased 1-year mortality was evident in patients who received antimicrobials <= 1 h (aOR 3.8, 95% CI 1.2, 11.7) or >3 h (aOR 3.5, 95% CI 1.3, 9.8) compared with patients who received antimicrobials within 1 to 3 h from sepsis recognition. For the subset of patients who survived index PICU admission, antimicrobial therapy <= 1 h was also associated with increased 1-year mortality (aOR 5.5, 95% CI 1.1, 27.4), while antimicrobial therapy >3 h was not associated with 1-year mortality (aOR 2.2, 95% CI 0.5, 11.0). Conclusions: Hourly delays to antimicrobial therapy, up to 3 h, were not associated with 1-year mortality in pediatric severe sepsis in this study. The finding that antimicrobial therapy <= 1 h from sepsis recognition was associated with increased 1-year mortality should be regarded as hypothesis-generating for future studies.
引用
收藏
页码:29 / 35
页数:7
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