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首页> 外文期刊>The Journal of Antimicrobial Chemotherapy >Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study.
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Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study.

机译：接受败血症的ICU患者经验性抗菌药物治疗不足引起的死亡率和发病率：一项配对队列研究。

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OBJECTIVES: To determine the attributable mortality and excess length of stay (LOS) associated with the use of inadequate empirical antimicrobial therapy in patients with sepsis at admission to the intensive care unit (ICU). METHODS: A retrospective matched cohort study was performed using a prospectively collected database at a 40 bed general ICU at a university public hospital. Patients who received inadequate antimicrobial therapy at admission to the ICU (exposed) were matched with controls (unexposed) on the basis of origin of sepsis, inflammatory response at admission, surgical or medical status, hospital- or community-acquired sepsis, APACHE II score (+/-2 points) and age (+/-10 years). Clinical outcome was assessed by in-hospital mortality, and this analysis was also performed in those pairs without nosocomial infection in the ICU. RESULTS: Eighty-seven pairs were successfully matched. Fifty-nine exposed patients died [67.8% mortality (95% CI, 58.0-77.6%)] and 25 unexposed controls died [28.7% mortality (95% CI, 19.2-38.2%)] (P < 0.001). Excess in-hospital mortality was estimated to be 39.1%. The rate of nosocomial infection was significantly higher in patients with inadequate empirical therapy (16.1%) than in those treated empirically with adequate antibiotics (3.4%) (P = 0.013). Excess in-hospital mortality was 31.4% after excluding those 17 pairs that developed a nosocomial infection in the ICU. Inadequate antimicrobial therapy was associated with a significant increment in duration of hospitalization (15 days in surviving pairs). CONCLUSIONS: Inadequate antimicrobial therapy at admission to the ICU with sepsis is associated with excess mortality and increases LOS.
机译：目的：确定因重症监护病房（ICU）败血症患者使用经验不足的抗菌药物治疗而导致的归因死亡率和超长住院时间（LOS）。方法：采用前瞻性收集的数据库，在一家大学公立医院的40张普通ICU上进行回顾性配对队列研究。根据败血症的起源，入院时的炎症反应，手术或医疗状况，医院或社区获得性败血症，APACHE II评分，将在ICU入院时接受抗微生物治疗不足的患者（暴露）与对照（未暴露）相匹配（未暴露） （+/- 2分）和年龄（+/- 10岁）。通过院内死亡率评估临床结局，并且在ICU中没有医院感染的那些配对中也进行了该分析。结果：87对成功匹配。 59名暴露患者死亡[67.8％死亡率（95％CI，58.0-77.6％）]和25名未暴露对照死亡[28.7％死亡率（95％CI，19.2-38.2％）]（P <0.001）。医院内死亡率过高估计为39.1％。经验疗法治疗不足的患者（16.1％）的医院感染率显着高于用适当抗生素经验治疗的患者（3.4％）（P = 0.013）。在排除了在ICU中发生医院感染的那17对后，医院中的过高死亡率为31.4％。抗菌药物治疗不足会导致住院时间显着增加（成对存活15天）。结论：进入败血症的加护病房的抗菌药物治疗不足会增加死亡率，并增加LOS。

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