- 期刊
Retrospective Study of Previous Antibiotic Exposure among Sepsis Patients in Intensive Care Units
加護病房敗血症患者過去抗生素暴露情形之回溯性研究
摘要
Introduction: Recent studies have found that antibiotic exposure within the last 3 months of sepsis development has an important effect on antibiotic selection and patient survival. This study assessed whether quantified previous antibiotic exposure (PAE) affects appropriate antibiotic use and outcomes in patients admitted to intensive care units (ICU) due to sepsis. Methods: A retrospective cohort study design was used to investigate septic patients with identified pathogens who were admitted to the ICU at Taipei Tzu Chi Hospital from January 1, 2014 to December 31, 2014. Data on disease severity and clinical outcomes such as mortality rates, length of stay in the ICU, and duration of vasopressor use were evaluated. Results: A total of 469 patients, of which 172 had PAE, were included in this study. Patients with PAE had a greater percentage of first treatment with an inappropriate antibiotic before admission to the ICU, and had a greater incidence of infection with multidrug-resistant organisms (MDRO). Patients with PAE had higher mortality than those without. But, after adjusting for disease severity, only APACHE II scores were associated with ICU and hospital mortality. Conclusions: PAE may correlate with higher initial inappropriate antibiotics selection, higher MDRO, and even higher mortality in patients admitted to the ICU due to sepsis. Therefore, early inquiry into the patient's PAE within the last 90 days, and careful administration, determination, and selection of antibiotic therapy are warranted.
並列摘要
背景：儘早用上適當的抗生素治療對於敗血症重症病人很重要。最近研究發現病人在過去3個月抗生素暴露對新發展的敗血症其抗生素的選擇有影響。本研究目的是評估加護病房（ICU）敗血症病人其過去抗生素使用情形是否會影響此次適當抗生素使用情形和病人預後。方法：回顧性世代研究，納入自2014年1月1日至12月31日由急診住院至台北慈濟醫院加護病房有培養出致病菌的敗血症患者，研究結果包括死亡率和ICU住院天數和升壓藥的使用時間。結果：共有469例患者納入研究族群；172例患者曾有90天內抗生素暴露史。先前抗生素暴露的患者比未暴露者在入住ICU之前接受了不適當的抗生素治療比率較高，分別為46.51%和34.34%。另外，先前抗生素暴露的患者有更大百分比具有MDRO（分別為35.47%對16.16%）。過去使用抗生素患者相對於無使用患者其ICU死亡率和住院死亡率較高。然而經校正疾病嚴重度，僅有APHACHE II scores與ICU死亡率以及住院死亡率有相關。結論：敗血症住院至加護病房的重症患者，住院前90天內使用抗生素患者有較高的入院第一針不適當抗生素比率，較高的多重抗藥性細菌比率，甚至較高的死亡率，因此及早查詢病患過去抗生素使用情形有助於敗血症抗生素選用。
延伸閱讀
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