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      패혈성 쇼크환자에서 초기 1시간이내 항생제 투약이 예후에 미치는 영향 = Critical care ; Early Antibiotic Administration and Mortality in Patients with Septic Shock in Emergency Department패혈성 쇼크환자에서 초기 1시간이내 항생제 투약이 예후에 미치는 영향

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      Purpose: The Surviving Sepsis Campaign recommend initiating broad spectrum antibiotics within the first hour of recognition of septic shock. An unknown proportion of the effectiveness of earlier antibiotics administration will remain in septic shock p...

      Purpose: The Surviving Sepsis Campaign recommend initiating broad spectrum antibiotics within the first hour of recognition of septic shock. An unknown proportion of the effectiveness of earlier antibiotics administration will remain in septic shock patients treated with an early quantitative resuscitation in emergency department (ED). We were to compare the 28-day mortality between earlier antibiotic administration (≤1 hour) and early antibiotic administration (1 hour to 6 hour) in septic shock patients in ED. Methods: A total of 536 consecutive septic shock patients were prospectively collected from January 2010 to June 2012. We identified 357 patients who were developed shock at initial assessment, and measured the time of initial antibiotics administration. The primary outcome was 28-day mortality. Results: Mean age was 62.8±13.7 years old and 222 patients were male (62.2%). The median time from shock recognition-to-antibiotics administration was 94.0 min (IQR 47.0-150.0) and 28-day mortality rate was 20.2%. When the relationship of 28-day mortality between earlier antibiot-ic administration (≤1 hour) and early antibiotic administra-tion (1 hour to 6 hour) was compared, no significant differ-ence was shown (19.5% vs. 20.5%, p=0.82). Conclusion: Earlier antibiotics administration may have no additional outcome value in septic shock patients treated with an early quantitative resuscitation in ED.

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      참고문헌 (Reference) 논문관계도

      1 Trzeciak S, "Translating research to clinical practice:a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department" Chest 129 : 225 ~ 232, 2006

      2 Levy MM, "The surviving sepsis campaign: Results of an international guideline-based performance improvement program targeting severe sepsis" Crit Care Med 38 : 367 ~ 374, 2010

      3 Martin GS, "The epidemiology of sepsis in the United States from 1979through 2000" N Engl J Med 348 : 1546 ~ 1554, 2000

      4 Labelle A, "The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment*" Crit Care Med 40 : 2016 ~ 2021, 2012

      5 Jones AE, "The Surviving Sepsis Campaign guidelines 2012 : update for emergency physicians" Ann Emerg Med 63 : 35 ~ 47, 2014

      6 Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine" Intensive Care Med 22 : 707 ~ 710, 1996

      7 Dellinger RP, "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008" Intensive Care Med 34 : 17 ~ 60, 2008

      8 Dellinger RP, "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012" Crit Care Med 41 : 580 ~ 637, 2013

      9 Teodorczyk JE, "Should we or should we not allow delays in antimicrobial administration?" Of course not! Crit Care Med 40 : 1035 ~ 1036, 2012

      10 Angus DC, "Severe sepsis and septic shock" N Engl J Med 369 : 840 ~ 851, 2013

      1 Trzeciak S, "Translating research to clinical practice:a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department" Chest 129 : 225 ~ 232, 2006

      2 Levy MM, "The surviving sepsis campaign: Results of an international guideline-based performance improvement program targeting severe sepsis" Crit Care Med 38 : 367 ~ 374, 2010

      3 Martin GS, "The epidemiology of sepsis in the United States from 1979through 2000" N Engl J Med 348 : 1546 ~ 1554, 2000

      4 Labelle A, "The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment*" Crit Care Med 40 : 2016 ~ 2021, 2012

      5 Jones AE, "The Surviving Sepsis Campaign guidelines 2012 : update for emergency physicians" Ann Emerg Med 63 : 35 ~ 47, 2014

      6 Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine" Intensive Care Med 22 : 707 ~ 710, 1996

      7 Dellinger RP, "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008" Intensive Care Med 34 : 17 ~ 60, 2008

      8 Dellinger RP, "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012" Crit Care Med 41 : 580 ~ 637, 2013

      9 Teodorczyk JE, "Should we or should we not allow delays in antimicrobial administration?" Of course not! Crit Care Med 40 : 1035 ~ 1036, 2012

      10 Angus DC, "Severe sepsis and septic shock" N Engl J Med 369 : 840 ~ 851, 2013

      11 Annane D, "Septic shock" Lancet 365 : 63 ~ 78, 2005

      12 Sohn CH, "Outcome of delayed resuscitation bundle achievement in emergency department patients with septic shock" Intern Emerg Med 9 : 671 ~ 676, 2014

      13 Gaieski DF, "Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department" Crit Care Med 38 : 1045 ~ 1053, 2010

      14 Angus DC, "Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care" Crit Care Med 29 : 1303 ~ 1310, 2001

      15 Ferrer R, "Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour : results from a guideline-based performance improvement program" Crit Care Med 42 : 1749 ~ 1755, 2014

      16 Capp R, "Effective antibiotic treatment prescribed by emergency physicians in patients admitted to the intensive care unit with severe sepsis or septic shock: where is the gap?" J Emerg Med 41 : 573 ~ 580, 2011

      17 Siddiqui S, "Early versus late pre-intensive care unit admission broad spectrum antibiotics for severe sepsis in adults" The Cochrane database Syst Rew 6 : CD007081 ~, 2010

      18 Kumar A, "Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock" Crit Care Med 34 : 1589 ~ 1596, 2006

      19 van Zanten AR, "Ciprofloxacin pharmacokinetics in critically ill patients : a prospective cohort study" J Crit Care 23 : 422 ~ 430, 2008

      20 Brindley PG, "Best evidence in critical care medicine : Early antibiotics and survival from septic shock : it’s about time" Can J Anesth 53 : 1157 ~ 1160, 2006

      21 Puskarich MA, "Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol" Crit Care Med 39 : 2066 ~ 2071, 2011

      22 Kim WY, "Analysis of progression in risk, injury, failure, loss, and end-stage renal disease classification on outcome in patients with severe sepsis and septic shock" J Crit Care 27 : 104e1 ~ 104e7, 2012

      23 Levy MM, "2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference" Crit Care Med 31 : 1250 ~ 1256, 2003

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