三级综合医院急诊实施脓毒症项目后，与血源性感染相关的死亡率有所降低。
Reduction of BSI associated mortality after a sepsis project implementation in the ER of a tertiary referral hospital.
发表日期：2023 Mar 29
作者：
Elena Seminari, Marta Colaneri, Marta Corbella, Annalisa De Silvestri, Alba Muzzi, Stefano Perlini, Ilaria Francesca Martino, Lea Nadia Marvulli, Alessia Arcuri, Marcello Maffezzoni, Rita Minucci, Enrica Bono, Patrizia Cambieri, Piero Marone, Raffaele Bruno
来源：
DIABETES & METABOLISM
摘要：
紧急诊室是败血症患者入院治疗的第一关口，确定可在此环境下应用的最佳实践和基准可能极大地提高患者的治疗效果。本研究旨在评估在紧急诊室开发的一项败血症项目中，减少院内死亡率的结果。本次回顾性观察研究纳入了2016年1月1日至2019年7月31日，到我院的急诊室进行疑似败血症检测（MEWS评分≥3）并进行血培养检查的患者。该研究分为两期: A期：从2016年1月1日至2017年12月31日，在实施败血症项目之前。B期：从2018年1月1日至2019年7月31日，在实施败血症项目之后。为了分析两个时期间死亡率的差异，采用单变量和多变量逻辑回归分析。院内死亡风险通过奥斯比比率（OR）和95%置信区间（95%CI）计算。总共722名入院患者初次就诊时血培养呈阳性，期A有408名，期B有314名。院内死亡率在A期为18.9％，在B期为12.7％（p = 0.03）。多变量分析显示，与A期相比，B期死亡率仍然降低（OR 0.64，95% CI 0.41-0.98; p = 0.045）。患有由GP细菌或多微生物引起的感染、肿瘤或糖尿病的患者死亡风险较高。在紧急诊室实施基于应用败血症束的败血症项目后，文献证明了患有体现感染和败血症症状的败血症证明B型血清素相关物减少会导致患者院内死亡率显著降低。 © 2023. The Author(s).
The emergency room (ER) is the first gateway for patients with sepsis to inpatient units, and identifying best practices and benchmarks to be applied in this setting might crucially result in better patient's outcomes. In this study, we want to evaluate the results in terms of decreased the in-hospital mortality of patients with sepsis of a Sepsis Project developed in the ER. All patients admitted to the ER of our Hospital from the 1st January, 2016 to the 31stJuly 2019 with suspect of sepsis (MEWS score ≥ of 3) and positive blood culture upon ER admission were included in this retrospective observational study. The study comprises of two periods: Period A: From the 1st Jan 2016 to the 31st Dec 2017, before the implementation of the Sepsis project. Period B: From the 1st Jan 2018 to the 31stJul 2019, after the implementation of the Sepsis project. To analyze the difference in mortality between the two periods, a univariate and multivariate logistic regression was used. The risk of in-hospital mortality was expressed as an odds ratio (OR) and a 95% confidence interval (95% CI). Overall, 722 patients admitted in ER had positive BC on admissions, 408 in period A and 314 in period B. In-hospital mortality was 18.9% in period A and 12.7% in period B (p = 0.03). At multivariable analysis, mortality was still reduced in period B compared to period A (OR 0.64, 95% CI 0.41-0.98; p = 0.045). Having an infection due to GP bacteria or polymicrobial was associated with an increased risk of death, as it was having a neoplasm or diabetes. A marked reduction in in-hospital mortality of patients with documented BSI associated with signs or symptoms of sepsis after the implementation of a sepsis project based on the application of sepsis bundles in the ER.© 2023. The Author(s).