A Prospective Study Of The Effects Of Directed The Anti-infection Therapy In Patients With Sepsis

Objective: To observe the effect of the anti-infection treatment strategies on outcomes in sepsis patients and provide guiding on practical, safe and effective anti-infection therapy protocol use.Methods : This study was a prospective, randomized, controlled clinical study. All patients in the Intensive Care Unit(ICU) and Department of Respiratory Medicine of Chengdu Military Area General Hospital from April 2014 to January 2015 were included. 50 patients were randomly divided into control group(C group) and direct the anti-infection therapy group(D group) by Random number table. C group received routine therapy. D group received direct the anti-infection therapy. Including, direct anti-infection therapies be based on the following principles for supervision and direction:(1)Etiological examination were practiced before getting antibiotics and replace antibiotics. The etiological examination include sputum samples culture, sputum-smear, peripheral blood culture and other body fluids or secretions etiology inspection.(2)When carries on the empirical antibiotic therapy, antimicrobial agents should be coving the major pathogenic bacterium.(3)The antibiotic treatment in patients with more severe infection should be conform to onset in time, hitting hard and combination of broad-spectrum antibiotics.(4)In etiology examination and identify pathogenic bacteria of 24 h should be applied the goal-directed therapy, namely De-escalation therapy strategy.(5) Short-term treatment strategy. The course of therapy is usually from 7-10 d for effective cases to antibiotics. For those patients of poor response, sometimes may be extended to 10-15 d for specific pathogen infection.( 6) Cycling use of antibiotics. To replace antibiotics after 5-8d treatment for some difficult infections.(7) Evaluation strategies of anti-infection therapy. Record the patient’s symptoms and evaluation of anti-infection in the progress notes. The length of stay in hospital, 7-days and 14-daysmortality, bacterial erdication rate, evaluation of anti-infection effect, hospitalization cost were collected. Meanwhile, myocardial enzymes、myocardial markers、blood urea nitrogen、creatinine and other index.Results: 50 patients enrolled in the prospective study. C group(24 patients), D group(26 patients). There are no statistical difference between two groups in the main demographic indices 。 The bacterial clearance rate, evaluation of anti-infection effect in D group is better than C group(15(62%)and 25(96%),18(69%)and 18(75%),P<0.05). Main observation indexes of other indicators to compare 7-day mortality、14-day mortality, hospitalization cost and hospital stay were no statistical significance(P>0.05).There are no statistical differences between two group in myocardial enzymes、 myocardial markers、blood urea nitrogen 、 creatinine 、 blood coagulation function and Liver enzymes and bilirubin(P>0.05).But D group of steady recovery was more quickly. SOFA score and amount of liquid treatment is no statistical significance(P>0.05).The PCT has falling faster than C group in 2 、 3 days after admission(P<0.05).Indirect evidence to D group effect is better than that of C group, to control infection of patients with sepsis.Conclusions: The directed anti-infection therapy can effectively improve the bacteria clearance rate, and the anti-infection effect evaluation for patients with sepsis. It can also promote sepsis patients recover faster from organ function failure, but it still cannot reduce the patients′ mortality.