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History of diabetes may delay antibiotic administration in patients with severe sepsis presenting to emergency departments

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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
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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