隆云;刘大为;
LONG Yun;LIU Da-wei;Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院重症医学科

摘要(Abstract)：

Sepsis不同于感染,是机体对感染的反应失控而导致的危及生命的器官功能障碍。Sepsis的重点在于器官功能障碍而非感染,这可能是美国感染病学会(Infectious Disease Society of America,IDSA)与"拯救Sepsis运动(Surviving Sepsis Campaign,SSC)"在重症感染认知上的分歧。对于Sepsis而言,筛查至关重要,可更早地启动集束性治疗策略,从而改善患者预后。Sepsis的理念来源于循证医学证据及大数据研究结果,二者奠定了其坚实的理论基础。本文根据IDSA提出的争议话题,从SSC角度,阐述重症医学对Sepsis本质的认知。
Sepsis is not equal to infection. It is defined as life-threatening organ-dysfunction caused by a dysregulated host response to infection. Sepsis focuses on organ dysfunction instead of the infection,which is the main difference of opinion between Infectious Disease Society of America( IDSA) and Surviving Sepsis Campaign( SSC). Screening is the most important thing for sepsis in order to initialize the sepsis therapy-bundles to improve the patients' outcome. The definition and concept of sepsis originate from the evidence-based medicine and big data study. The methodology of sepsis keeps its development potential. This article interpreted the essence of sepsis to support SSC and disprove the opinions of IDSA.

关键词(KeyWords)： Sepsis;感染;拯救Sepsis运动;指南
sepsis;infection;Surviving Sepsis Campaign;guideline

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 隆云;刘大为;
LONG Yun;LIU Da-wei;Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

Email:

DOI:

参考文献(References)：

• [1]IDSA Sepsis Task Force.Infectious Diseases Society of America(IDSA)Position Statement:Why IDSA Did Not Endorse the Surviving Sepsis Campaign Guidelines[J].Clin Infect Dis,2018,66:1631-1635.
• [2]Klein Klouwenberg PM,Cremer OL,van Vught LA,et al.Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission:a cohort study[J].Crit Care,2015,19:319.
• [3]Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315:801-810.
• [4]Ferrer R,Martin-Loeches I,Phillips G,et al.Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour:results from a guideline-based performance improvement program[J].Crit Care Med,2014,42:1749-1755.
• [5]Rhodes A,Evans LE,Alhazzani W,et al.Surviving Sepsis Campaign:International Guidelined for Management of Sepsis and Septic Shock:2016[J].Crit Care Med,2017,43:486-552.
• [6]Alsolamy S,Al Salamah M,Al Thagafi M,et al.Diagnostic accuracy of a screening electronic alert tool for severe sepsis and septic shock in the emergency department[J].BMC Med Inform Decis Mak,2014,14:105.
• [7]Dellinger RP,Levy MM,Rhodes A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:2012[J].Crit Care Med,2013,41:580-637.
• [8]Goulden R,Hoyle MC,Monis J,et al.q SOFA,SIRS and NEWS for predicting inhospital mortality and ICU admission in emergeney admissions treated as sepsis[J].Emerg Med J,2018,35:345-349.
• [9]Gyang E,Shieh L,Forsey L,et al.A nurse-driven screening tool for the early identification of sepsis in an intermediate care unit setting[J].J Hosp Med,2015,10:97-103.
• [10]Jones SL,Ashton CM,Kiehne L,et al.Reductions in sepsis mortality and costs after design and implementation of a nurse-based early recognition and response program[J].Jt Comm J Qual Patient Saf,2015,41:483-491.
• [11]Levy MM,Rhodes A,Phillips GS,et al.Surviving Sepsis Cam-paign:association between performance metrics and outcomes in a 7.5-year study[J].Crit Care Med,2015,43:3-12.
• [12]Cockerill FR 3rd,Wilson JW,Vetter EA,et al.Optimal testing parameters for blood cultures[J].Clin Infect Dis,2004,38:1724-1730.
• [13]Lee A,Mirrett S,Reller LB,et al.Detection of Bloodstream Infections in Adults:How Many Blood Cultures Are Needed?[J].J Clin Microbiol,2007,45:3546-3548.
• [14]Mermel LA,Allon M,Bouza E,et al.Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection:2009 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2009,49:1-45.
• [15]Andes DR,Safdar N,Baddley JW,et al.Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis:a patient-level quantitative review of randomized trials[J].Clin Infect Dis,2012,54:1110-1122.
• [16]Kumar A,Zarychanski R,Light B,et al.Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock:a propensity-matched analysis[J].Crit Care Med,2010,38:1773-1785.
• [17]Brunkhorst FM,Oppert M,Marx G,et al.Effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients with severe sepsis:a randomized trial[J].JAMA,2012,307:2390-2399.
• [18]de Jong E,van Oers JA,Beishuizen A,et al.Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients:a randomised,controlled,open-label trial[J].Lancet Infect Dis,2016,16:819-827.
• [19]Prkno A,Wacker C,Brunkhorst FM,et al.Procalcitoninguided therapy in intensive care unit patients with severe sepsis and septic shock—a systematic review and metaanalysis[J].Crit Care,2013,17:R291.
• [20]Blot SI,Pea F,Lipman J.The effect of pathophysiology on pharmacokinetics in the critically ill patient—concepts appraised by the example of antimicrobial agents[J].Adv Drug Deliv Rev,2014,77:3-11.
• [21]Avni T,Levcovich A,Ad-El DD,et al.Prophylactic antibiotics for burns patients:systematic review and meta-analysis[J].BMJ,2010,340:c241.
• [22]Barajas-Nava LA,López-Alcalde J,Roquéi Figuls M,et al.Antibiotic prophylaxis for preventing burn wound infection[J].Cochrane Database Syst Rev,2013,6:CD008738.
• [23]Sawyer RG,Claridge JA,Nathens AB,et al.Trial of shortcourse antimicrobial therapy for intraabdominal infection[J].N Engl J Med,2015,372:1996-2005.
• [24]Eliakim-Raz N,Yahav D,Paul M,et al.Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection-7 days or less versus longer treatment:systematic review and meta-analysis of randomized controlled trials[J].J Antimicrob Chemother,2013,68:2183-2191.
• [25]Rattan R,Allen CJ,Sawyer RG,et al.Patients with complicated intra-abdominal infection presenting with sepsis do not require longer duration of antimicrobial therapy[J].J Am Coll Surg,2016,222:440-446.
• [26]Hepburn MJ,Dooley DP,Skidmore PJ,et al.Comparison of short-course(5 days)and standard(10 days)treatment for uncomplicated cellulitis[J].Arch Intern Med,2004,164:1669-1674.
• [27]Seymour CW,Liu VX,Iwashyna TJ,et al.[J].JAMA,2016,315:762-774.
• [28]Shankar-Hari M,Phillips GS,Levy ML,et al.Developing a New Definition and Assessing New Clinical Criteria for Septic Shock:For the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315:775-787.