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首页> 外文期刊>Canadian Journal of Emergency Medicine >Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis
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Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis

机译：急诊脓毒症治疗方案对严重脓毒症患者使用抗生素的时间的影响

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Objective:We sought to evaluate the time to antibiotics for emergency department (ED) patients meeting criteria for severe sepsis before and after the implementation of an ED sepsis protocol. Compliance with published guidelines for time to antibiotics and initial empiric therapy in sepsis was also assessed.Methods:A retrospective chart review was conducted. Emergency department patient encounters with International Classification of Diseases codes related to severe infections were screened during a 3-month period before and after the implementation of a sepsis protocol. Encounters meeting criteria for severe sepsis were further assessed. The time to initiation of antibiotics was determined as well as the initial choice of antimicrobial therapy based on the presumed source of infection.Results:We reviewed 213 unique ED patient encounters meeting criteria for severe sepsis. Analysis of the period before implementation showed a median time from the time criteria for severe sepsis were met to delivery of antibiotics of 163 minutes (95% confidence interval [CI] 124 to 210 min). Analysis of the period after implementation of the protocol revealed a median time of 79 minutes (95% CI 64 to 94 min), representing an overall reduction of 84 minutes (95% CI 42 to 126 min). Before the implementation of the protocol, 47% of patients received correct antibiotic coverage for the presumed source of infection in compliance with locally published guidelines. After the initiation of the protocol, 73% received appropriate initial antibiotics, for an overall improvement of 26%.Conclusion:A guideline-based ED sepsis protocol for the evaluation and treatment of the septic patient appears to improve the time to administration of antibiotics as well as the appropriateness of initial antibiotic therapy in patients with severe sepsis.
机译：目的：我们试图评估急诊脓毒症方案实施前后脓毒症患者符合严重脓毒症标准的时间。还评估了脓毒症患者使用抗生素和初步经验性治疗的时间是否符合已发布的指南。方法：进行回顾性图表审查。在脓毒症实施方案实施前后的3个月内，对急诊科患者遇到与严重感染有关的国际疾病分类代码的情况进行了筛选。符合严重脓毒症标准的会得到进一步评估。结果：我们回顾了213例符合严重脓毒症标准的ED患者，并回顾了其初始感染时间以及根据抗生素的最初感染源选择抗菌药物的初步选择。实施前的时间段分析显示，从达到严重脓毒症的时间标准到递送抗生素的中位时间为163分钟（95％置信区间[CI] 124至210分钟）。实施方案后的时间段分析显示，平均时间为79分钟（95％CI为64至94分钟），总体减少了84分钟（95％CI为42至126分钟）。在实施该方案之前，按照当地公布的指南，47％的患者针对推定的感染源接受了正确的抗生素覆盖。方案启动后，有73％的人接受了适当的初始抗生素治疗，总体改善了26％。结论：基于指南的ED败血症方案用于评估和治疗败血症患者似乎可以缩短抗生素的使用时间，因为以及严重败血症患者初始抗生素治疗的适当性。

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