Effect Of Timing Of Early Antibiotic Treatment On Prognosis Of Sepsis Associated With Pneumonia

Objective:To investigate the relationship between the timing of early antibiotic administration and prognosis in patients with sepsis associated with pneumonia in EDMethods:This project is a prospective,single-center,observational study conducted in the ED.This research project was carried out from February to August 2018 in the ED of the second affiliated hospital of kunming medical university.Included as subjects of observation and study who were explicitly diagnosed as pulmonary infection-associated sepsis,The diagnostic criteria of pulmonary infection were based on the Chinese guidelines for the diagnosis and treatment of community-acquired pneumonia in adults(2016 edition).The diagnostic criteria of sepsis are based on the international consensus on the definition of sepsis and septic shock in the third edition.Pulmonary infection+qSOFA score>2 was used as the diagnostic criterion of suspected sepsis related to pulmonary infection.Once a suspected diagnosis is met,refer to the Diagnostic and Therapeutic Guide for Acquired Pneumonia in the Chinese Adult Community(2016 Edition)>Select the appropriate antimicrobial agent and refer to the<2016 SSC International Sepsis Guide>for additional treatment,The SOFA score was performed after all suspected lung infection-related sepsis patients were complete with the relevant auxiliary examination,and if the SOFA score was 2,it was clearly diagnosed as pulmonary infection-related sepsis.The general data of patients,consciousness,vital signs,first arterial blood gas analysis,blood cell analysis,blood biochemical test,PCT,aerobic/anaerobic blood culture results,first 24-hour urine volume were recorded.According to the above data,APACHE ? score and other related evaluation were completed.The registration time of the patients in the emergency medical department,the time of preliminary diagnosis or definite diagnosis of sepsis associated with pulmonary infection,the time of the first use of antibiotics,and finally the follow-up of the patients and their families were recorded.The survival status of the patients in hospital and 90 days were recorded.The main risk factors were the interval between the preliminary diagnosis of pulmonary infection-related sepsis and the first use of antibiotics in the hospital,and the main outcomes were hospitalization all-cause mortality and 90-day all-cause mortality.Results:A total of 107 patients with sepsis related to pulmonary infection were included.After systematic exclusion,the data of the final 70 patients were statistically analyzed.17 patients with sepsis related to pulmonary infection died in hospital,the all-cause mortality rate was 24.3%,22 patients died on 90 days,and the 90-day all-cause mortality rate was 31.4%.The average interval from patient registration to diagnosis of sepsis is 137.35 minutes(standard deviation:106.84,range:2-388min).The average interval between the initial diagnosis of sepsis and the first use of antibiotics in hospital was 192.51 minutes(standard deviation:126.50,range 15-450min).Hospitalized all-cause mortality ratio?1 hour for first-time use of antimicrobial agents for the first time in the first hour was lower than in-hospital all-cause mortality of>1 hour(All-cause mortality in the hospital for?1 h=5.26%,all-cause mortality in the hospital>1 h=31.37%,OR=0.12,95%CI=0.02-0.99,P--0.023).The all-cause hospital mortality of the first use of antibiotics?6 hours was lower than that of>6 hours(?6 h total cause hospital mortalit)17.74%,>6 h hospital total cause mortality=75%,OR=13.90,95%CI=2.47-78.29,P<0.001).The 90-day all-cause mortality rate of the first use of antibiotics within 1 hour was lower than that of more than 1 hour,compared with more than 1 hour,and the all-cause mortality rate within 1 hour was lower than that of more than 1 hour(?1h90 all-cause mortality=10.53%,>1h90-day mortalitty=39.22%,OR=0.18,95%CI=0.04-0.88,P=0.021).The 90-day all-cause mortality rate of using antibiotics for more than 6 hours was higher than that of using antibiotics within 6 hours.(>6 h 90 day all cause mortality=75%.?6h 90day all cause mortality=25.81%,OR=8.62,95%CI=1.58-4.14,P=0.044).The first antimicrobial agent was hospitalized with a time interval of 3 hours and the 90-day full-cause mortality was not statistically significant as compared to those with>3 hours.Conclusion:Of the 70 patients included in this single-center prospective study,the results were generally in line with SSC guidelines for sepsis:the first use of antibiotics within an hour after the diagnosis of sepsis had a positive impact on the prognosis of sepsis patients.The in-hospital mortality and 90-day mortality of sepsis patients with antibiotic delay longer than 6 hours were significantly increased.Since this study is a single-center prospective observation study,involving a limited number of cases,the results of the study may be limited by insufficient number of cases,looking forward to more forward-looking,large-scale,Multicenter clinical study further explored the impact of early antibiotic use on prognosis of pulmonary infection-associated sepsis.