期刊
CRITICAL CARE MEDICINE
卷 45, 期 5, 页码 759-765出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000002264
关键词
antibiotic; prehospital care; sepsis; timing
资金
- National Institutes of Health [K23GM104022]
- National Institutes of Health (NIH)/National Institute of General Medical Sciences
- Beckman Coulter, Cytovale, and Edwards
- NIH
- U.S. Department of Health and Human Services (NIH)
- U.S. Department of Health and Human Services (Health Resources & Services Administration)
- Gordon and Betty Moore Foundation
- American College of Emergency Physicians
- Lippincott
- UpToDate
- Oxford University Press
- Canadian Institute for Health Research
- Physicians' Services Incorporated Foundation (Fellowship in Translational Health Research)
- Bayer HealthCare
- Ferring Pharmaceuticals
- GlaxoSmithKline
Objective: To evaluate the association between total medical contact, prehospital, and emergency department delays in antibiotic administration and in-hospital mortality among patient encounters with community-acquired sepsis. Design: Retrospective cohort study. Setting: Nine hospitals served by 21 emergency medical services agencies in southwestern Pennsylvania from 2010 through 2012. Patients: All emergency medical services encounters with community acquired sepsis transported to the hospital. Measurements and Main Results: Among 58,934 prehospital encounters, 2,683 had community-acquired sepsis, with an in-hospital mortality of 11%. Median time from first medical contact to antibiotic administration (total medical contact delay) was 4.2 hours (interquartile range, 2.7-8.0 hr), divided into a median prehospital delay of 0.52 hours (interquartile range, 0.40-0.66 hr) and a median emergency department delay of 3.6 hours (inter quartile range, 2.1-7.5 hr). In a multivariable analysis controlling for other risk factors, total medical contact delay was associated with increased in-hospital mortality (adjusted odds ratio for death, 1.03 [95% CI, 1.00-1.05] per 1-hr delay; p < 0.01), as was emergency department delay (p = 0.04) but not prehospital delay (p = 0.61). Conclusions: Both total medical contact and emergency department delay in antibiotic administration are associated with in hospital mortality in community-acquired sepsis.
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