부산대학교 도서관

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection and is one of the leading causes of death worldwide (1,2). There are 48 million [...]
BACKGROUND: Bloodstream infections in septic patients may be missed due to preceding antibiotic therapy prior to obtaining blood cultures. We leveraged the FABLED cohort study to determine if the quick Sequential Organ Failure Assessment (qSOFA) score could reliably identify patients at higher risk of bacteremia in patients who may have false negative blood cultures due to previously administered antibiotic therapy. METHODS: We conducted a multi-centre diagnostic study among adult patients with severe manifestations of sepsis. Patients were enrolled in one of seven participating centres between November 2013 and September 2018. All patients from the FABLED cohort had two sets of blood cultures drawn prior to the administration of antimicrobial therapy, as well as additional blood cultures within 4 hours of treatment initiation. Participants were categorized according to qSOFA score, with a score [greater than or equal to]2 being considered positive. RESULTS: Among 325 patients with severe manifestations of sepsis, a positive qSOFA score (defined as a score [greater than or equal to]2) on admission was 58% sensitive (95% CI 48% to 67%) and 41% specific (95% CI 34% to 48%) for predicting bacteremia. Among patients with negative post-antimicrobial blood cultures, a positive qSOFA score was 57% sensitive (95% CI 42% to 70%) and 42% specific (95% CI 35% to 49%) to detect patients who were originally bacteremic prior to the initiation of therapy. CONCLUSIONS: Our results suggest that the qSOFA score cannot be used to identify patients at risk for occult bacteremia due to the administration of antibiotics pre-blood culture. KEYWORDS: bacteremia, bloodstream infection, qSOFA, sepsis, severe sepsis HISTORIQUE : Les infections sanguines peuvent rester non diagnostiquees chez les patients septiques avant l'obtention des cultures sanguines, en raison d'une antibiotherapie anterieure. Les chercheurs ont puise dans l'etude de cohorte FABLED pour determiner si le score rapide de l'evaluation sequentielle d'insuffisance des organes (Sequential Organ Failure Assessment, qSOFA) pourrait depister les patients a plus haut risque de bacteriemie avec fiabilite, malgre la possibilite de cultures sanguines faussement negatives en raison d'une antibiotherapie anterieure. METHODOLOGIE : Les chercheurs ont realise une etude diagnostique multicentrique chez des patients adultes ayant de graves manifestations de sepsis. Les patients ont ete inscrits dans l'un des sept centres participants entre novembre 2013 et septembre 2018. Tous les patients de l'etude de cohorte FABLED avaient subi deux series de cultures sanguines avant de recevoir une therapie antimicrobienne, de meme qu'une autre serie de cultures sanguines dans les quatre heures suivant le debut du traitement. Les participants ont ete classes en fonction de leur score de qSOFA, un score d'au moins 2 etant considere comme positif. RESULTATS : Chez les 325 patients ayant de graves manifestations de sepsis, un score de qSOFA positif (defini comme un score d'au moins 2) a l'admission etait sensible a 58 % (IC a 95 %, 48 % a 67 %) et specifique a 41 % (IC a 95 %, 34 % a 48 %) pour predire la bacteriemie. Chez les patients dont les cultures sanguines etaient negatives apres la prise d'antimicrobiens, un score de qSOFA positif etait sensible a 57 % (IC a 95 %, 42 % a 70 %) et specifique a 42 % (IC a 95 %, 35 % a 49 %) pour depister les patients atteints d'une bacteriemie avant le debut du traitement. CONCLUSIONS : Selon les resultats, le score de qSOFA ne peut pas etre utilise pour depister les patients a risque de bacteriemie occulte a cause de l'administration d'antibiotiques avant la culture sanguine. MOTS-CLES : bacteriemie, infection sanguine, qSOFA, sepsis, sepsis grave