結論 : 急診敗血症病患經驗性抗生素投予與病患預後及危險因子的關聯性分析
中發現大部分病患接受投予適當經驗性抗生素，病患的死亡率為15.3 %。皮膚感染或血液透析病患不適當投予經驗性抗生素機率較高。在急診室使用血管增壓劑病患是容易造成死亡危險的相關因子，而疾病嚴重度APACHE分數高的病患是比較接近造成死亡危險的相關因子。
Objective : A prompt institution of antimicrobial therapy that is active against the causative pathogen(s) is crucial for the treatment of patients with severe infections and sepsis. In fact, the Surviving Sepsis Campaign strongly recommends initiating empirical antibiotic therapy within the first hour of recognition of severe sepsis, after suitable cultures have been obtained. Our main objective was to determine whether the administration of inadequate empirical antimicrobial therapy and to assess the risk factors of the use of empirical antibiotic therapy on survival of patients with bacteraemia and sepsis in an emergency room .
Materials and methods: We enrolled retrospectively of patients who was admitted and treated for sepsis from an emergency room during July 2010 through June 2011. Eligible patients meet the following criterias: (1) positive blood culture ; (2) two or more systemic in?ammatory response syndrome (SIRS) criteria . (3) age more than 20 years old ; excluded patients who required immediate surgical intervention .Variables of each case record at baseline and during follow-up include patients’ demographics, physical examination findings (vital signs and APACHE score ) , laboratory measurements ( biochemistry and microbiological cultures ) , suspected source of infection, initial empirical antibiotic use, outcome and mortality during 30 days .
Results : In this study , total 288 patients were enrolled . There were 238 cases were classified to appropriated empiric antibiotic treatment , about for 82.6 % of total cases. There were 50 cases was inappropriated empiric treatment group, about 17.4 % of total cases . The useage of vessopressin in severe septicemia patients was significant ( p < 0.05 ) , it was also that there was more portions of appropriated empiric antibiotic treatment in useage of vessopressin and severe septicemia patients . The total motality cases were 44 patients , about 15.3 % of total cases . The motality rate was higher if there was isolated with Pseudomonas aeruginosa or Methicillin resistant Staphylococcus aureus .Multiple logistic regression analysis identified that useage of vassoprssin was the only risk factor for fatal outcome ; the higher of APACHE scores of patients was closer of the risk factor for fatal outcome .
Conclusion : The majority of patients were administrated with appropriated empiric antibiotic treatment for whom with septicemia in an Emergency room . The total motality rate was 15.3 % . The useage of vassoprssin was the only risk factor for fatal outcome ; the higher of APACHE scores of patients was closer of the risk factor for fatal outcome .
