延迟抗菌治疗与增加儿童严重脓毒症病死率和器官功能紊乱风险的临床分析

Clinical analysis of the association between delayed antimicrobial administration with mortality and organ dysfunction duration in pediatric sepsis

目的：探讨延迟抗菌治疗对儿童严重脓毒症死亡和器官功能紊乱风险的影响。方法：回顾性分析85例严重脓毒症患儿临床资料,分析从确诊后首次给予抗菌药物治疗,每小时延迟给药对患儿病死率（主要事件）、无血管活性期、无机械通气期、无器官衰竭期和住院时间的影响。结果：严重脓毒症患儿从确诊后首次给予抗菌药物治疗的中位时间为137min（64-265min）;延迟首次给予抗菌药物〉3h,死亡风险OR为4.54（95%CI：1.55-16.42）;严重脓毒症患儿初始给予抗菌药物治疗≤3h和〉3h的无器官功能衰竭期比较差异有统计学意义[20（5-27）d vs.15（2-23）d,P〈0.05]。结论：延迟抗菌治疗是严重脓毒症患儿病死率和持续器官功能性紊乱发生的独立风险因素。

Objective：To investigate the impact of antimicrobial timing on mortality and organ dysfunction in pediatric patients with severe sepsis.Method：A retrospective case-control study was performed on 85 patients with initial antimicrobial administration.Hourly delays from severe sepsis recognition to initial antimicrobial administration were associated with mortality（primary outcome）,ventilator-free,vasoactive-free,organ failure-free day and length of stay.Result：The median time from severe sepsis recognition to initial antimicrobial administration was137minutes（interquartile range,64-265min）.For patients with more than 3-hour delay to initial antimicrobials,the odds ratio for mortality was 4.54（95%CI,1.55-16.42）.Initial antimicrobial administration more than 3hours was also associated with fewer organ failure-free days[20d（interquartile range,5-27d）vs 15d（interquartile range,2-23d）,P〈0.05）.Conclusion：Delayed antimicrobial therapy was an independent risk factor for mortality and prolonged organ dysfunction in pediatric patients with severe sepsis.