Patient and Organizational Factors Associated With Delays in Antimicrobial Therapy for Septic Shock*
| Autor: | Andre C K B, Amaral, Robert A, Fowler, Ruxandra, Pinto, Gordon D, Rubenfeld, Paul, Ellis, Brian, Bookatz, John C, Marshall, Greg, Martinka, Sean, Keenan, Denny, Laporta, Daniel, Roberts, Anand, Kumar, Kym, Wiebe |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Time Factors 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents Risk Factors medicine Humans 030212 general & internal medicine Intensive care medicine Retrospective Studies Critically ill business.industry Septic shock Retrospective cohort study Middle Aged bacterial infections and mycoses Antimicrobial medicine.disease Quality Improvement Shock Septic Intensive Care Units Shock (circulatory) Female medicine.symptom business |
| Zdroj: | Critical Care Medicine. 44:2145-2153 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/ccm.0000000000001868 |
| Popis: | To identify clinical and organizational factors associated with delays in antimicrobial therapy for septic shock.In a retrospective cohort of critically ill patients with septic shock.Twenty-four ICUs.A total of 6,720 patients with septic shock.None.Higher Acute Physiology Score (+24 min per 5 Acute Physiology Score points; p0.0001); older age (+16 min per 10 yr; p0.0001); presence of comorbidities (+35 min; p0.0001); hospital length of stay before hypotension: less than 3 days (+50 min; p0.0001), between 3 and 7 days (+121 min; p0.0001), and longer than 7 days (+130 min; p0.0001); and a diagnosis of pneumonia (+45 min; p0.01) were associated with longer times to antimicrobial therapy. Two variables were associated with shorter times to antimicrobial therapy: community-acquired infections (-53 min; p0.001) and higher temperature (-15 min per 1°C; p0.0001). After adjusting for confounders, admissions to academic hospitals (+52 min; p0.05), and transfers from medical wards (medical vs surgical ward admission; +39 min; p0.05) had longer times to antimicrobial therapy. Admissions from the emergency department (emergency department vs surgical ward admission, -47 min; p0.001) had shorter times to antimicrobial therapy.We identified clinical and organizational factors that can serve as evidence-based targets for future quality-improvement initiatives on antimicrobial timing. The observation that academic hospitals are more likely to delay antimicrobials should be further explored in future trials. |
| Databáze: | OpenAIRE |
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