| Title: | History of diabetes may delay antibiotic administration in patients with severe sepsis presenting to emergency departments |
| Authors: | Abe, Toshikazu Browse this author |
| Suzuki, Tomoharu Browse this author |
| Kushimoto, Shigeki Browse this author →KAKEN DB |
| Fujishima, Seitaro Browse this author →KAKEN DB |
| Sugiyama, Takehiro Browse this author |
| Iwagami, Masao Browse this author →KAKEN DB |
| Ogura, Hiroshi Browse this author →KAKEN DB |
| Shiraishi, Atsushi Browse this author →KAKEN DB |
| Saitoh, Daizoh Browse this author →KAKEN DB |
| Mayumi, Toshihiko Browse this author →KAKEN DB |
| Iriyama, Hiroki Browse this author |
| Komori, Akira Browse this author |
| Nakada, Taka-Aki Browse this author →KAKEN DB |
| Shiino, Yasukazu Browse this author |
| Tarui, Takehiko Browse this author |
| Hifumi, Toru Browse this author |
| Otomo, Yasuhiro Browse this author →KAKEN DB |
| Okamoto, Kohji Browse this author |
| Umemura, Yutaka Browse this author →KAKEN DB |
| Kotani, Joji Browse this author →KAKEN DB |
| Sakamoto, Yuichiro Browse this author →KAKEN DB |
| Sasaki, Junichi Browse this author →KAKEN DB |
| Shiraishi, Shin-Ichiro Browse this author →KAKEN DB |
| Tsuruta, Ryosuke Browse this author →KAKEN DB |
| Hagiwara, Akiyoshi Browse this author |
| Yamakawa, Kazuma Browse this author →KAKEN DB |
| Takuma, Kiyotsugu Browse this author →KAKEN DB |
| Masuno, Tomohiko Browse this author →KAKEN DB |
| Takeyama, Naoshi Browse this author →KAKEN DB |
| Yamashita, Norio Browse this author |
| Ikeda, Hiroto Browse this author |
| Ueyama, Masashi Browse this author |
| Gando, Satoshi Browse this author →KAKEN DB |
| Keywords: | bundle |
| comorbidity |
| diabetes mellitus |
| protocols |
| sepsis |
| Issue Date: | Mar-2020 |
| Publisher: | Lippincott Williams & Wilkins (LWW) |
| Journal Title: | Medicine |
| Volume: | 99 |
| Issue: | 11 |
| Start Page: | e19446 |
| Publisher DOI: | 10.1097/MD.0000000000019446 |
| Abstract: | Clinical manifestations of sepsis differ between patients with and without diabetes mellitus (DM), and these differences could influence the clinical behaviors of medical staff. Therefore, we aimed to investigate whether pre-existing DM was associated with the time to antibiotics or sepsis care protocols. This was a retrospective cohort study. It conducted at 53 intensive care units (ICUs) in Japan. Consecutive adult patients with severe sepsis admitted directly to ICUs form emergency departments from January 2016 to March 2017 were included. The primary outcome was time to antibiotics. Of the 619 eligible patients, 142 had DM and 477 did not have DM. The median times (interquartile ranges) to antibiotics in patients with and without DM were 103 minutes (60-180 minutes) and 86 minutes (45-155 minutes), respectively (P = .05). There were no significant differences in the rates of compliance with sepsis protocols or with patient-centred outcomes such as in-hospital mortality. The mortality rates of patients with and without DM were 23.9% and 21.6%, respectively (P = .55). Comparing patients with and without DM, the gamma generalized linear model-adjusted relative difference indicated that patients with DM had a delay to starting antibiotics of 26.5% (95% confidence intervals (95%CI): 4.6-52.8, P = .02). The gamma generalized linear model-adjusted relative difference with multiple imputation for missing data of sequential organ failure assessment was 19.9% (95%CI: 1.0-42.3, P = .04). The linear regression model-adjusted beta coefficient indicated that patients with DM had a delay to starting antibiotics of 29.2 minutes (95%CI: 6.8-51.7, P = .01). Logistic regression modelling showed that pre-existing DM was not associated with in-hospital mortality (odds ratio, 1.26; 95%CI: 0.72-2.19, P = .42). Pre-existing DM was associated with delayed antibiotic administration among patients with severe sepsis or septic shock; however, patient-centred outcomes and compliance with sepsis care protocols were comparable. |
| Rights: | https://creativecommons.org/licenses/by-nc/4.0/ |
| Type: | article |
| URI: | http://hdl.handle.net/2115/78183 |
| Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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