masterThesis
Impacto de la antibioticoterapia empírica temprana en pacientes pediátricos con sepsis en la UCIP de FCI
Fecha
2009Registro en:
TEME 0031 2009
Autor
Ortegón Parra, Lizeth
Fernández Sarmiento, Jaime
Céspedes Londoño, Jaime Aurelio
Mullett, Hernando
Godoy, Javier
Briseño, Germán
Institución
Resumen
Introduction: Sepsis is an increasingly common worldwide health problem, in which the first few hours of treatment have a dramatic effect on the chances of survival. Results from studies on the early use of antibiotic therapy in adults were extrapolated to determine the effects of such use on children.
Objectives: To determine if there is a connection between the early use of antibiotic therapy and the mortality rate amongst patients with severe sepsis and/or septic shock, who attended at UCIP of FCI.
Methods: A retrospective analytical study was undertaken, of cases and controls of patients aged between 1 month and 18 years old who presented with severe sepsis and/or septic shock, where the time of initial diagnosis was known, as well as the time the first dose of antibiotic was administered, and the final outcome. Patients who had received previous doses of antibiotic therapy were excluded. The mortality rate was compared with the time the course of antibiotic therapy was first started, calculating the OR and controlling other variables associated with the mortality rate.
Results: Of 108 cases evaluated the mortality rate was found to be 38.9%. In fatal cases the time between initial diagnostic and the first antibiotic being administered was 9,06 hours while in those who survived it was 6,1 hours. Empirical studies showed that those who received antibiotic therapy late (>6 hours) had a higher fatality rate by a factor of 3.8 (P:0,002). In addition to the late commencement of antibiotic therapy OR10.1(P:0.005) other factors which increase the risk of death include, persistent acidosis OR:10.14(P:0.00001); or acute renal injury OR:7.86(P:0.003).
Conclusion: An important connection exists between the early commencement of antibiotic therapy and the mortality rate, in patients who present with severe sepsis or septic shock. It is recommended that a course of antibiotic therapy be started as soon as possible with these patients.