期刊
CRITICAL CARE MEDICINE
卷 42, 期 11, 页码 2409-2417出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000000509
关键词
antimicrobial; critically ill children; delay; mortality; sepsis; timing
资金
- Endowed Chair, Department of Anesthesia and Critical Care, Division of Emergency Medicine
- Office of the Chief Medical Office at The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine
- Pediatric Critical Care and Scientist Development Program K12
- CHOP Center for Pediatric Clinical Effectiveness
- Emergency medicine and critical care
- National Institutes of Health (NIH) (National Heart, Lung, and Blood Institute [NHLBI]) [K12 HL109009]
- NIH-NHLBI
- Perelman School of Medicine University of Pennsylvania
- Agency for Healthcare Research and Quality
- Emergency Medical Services for Children
- U.S. Food and Drug Administration
- NHLBI K12 grant [HL109009]
Objectives: Delayed antimicrobials are associated with poor outcomes in adult sepsis, but data relating antimicrobial timing to mortality and organ dysfunction in pediatric sepsis are limited. We sought to determine the impact of antimicrobial timing on mortality and organ dysfunction in pediatric patients with severe sepsis or septic shock. Design: Retrospective observational study. Setting: PICU at an academic medical center. Patients: One hundred thirty patients treated for severe sepsis or septic shock. Interventions: None. Measurements and Main Results: We determined if hourly delays from sepsis recognition to initial and first appropriate antimicrobial administration were associated with PICU mortality (primary outcome); ventilator-free, vasoactive-free, and organ failure-free days; and length of stay. Median time from sepsis recognition to initial antimicrobial administration was 140 minutes (interquartile range, 74-277 min) and to first appropriate antimicrobial was 177 minutes (90-550 min). An escalating risk of mortality was observed with each hour delay from sepsis recognition to antimicrobial administration, although this did not achieve significance until 3 hours. For patients with more than 3-hour delay to initial and first appropriate antimicrobials, the odds ratio for PICU mortality was 3.92 (95% CI, 1.27-12.06) and 3.59 (95% CI, 1.09-11.76), respectively. These associations persisted after adjustment for individual confounders and a propensity score analysis. After controlling for severity of illness, the odds ratio for PICU mortality increased to 4.84 (95% CI, 1.45-16.2) and 4.92 (95% CI, 1.30-18.58) for more than 3-hour delay to initial and first appropriate antimicrobials, respectively. Initial antimicrobial administration more than 3 hours was also associated with fewer organ failure-free days (16 [interquartile range, 1-23] vs 20 [interquartile range, 6-26]; p = 0.04). Conclusions: Delayed antimicrobial therapy was an independent risk factor for mortality and prolonged organ dysfunction in pediatric sepsis.
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