{"id":28424,"date":"2025-07-20T04:17:00","date_gmt":"2025-07-19T20:17:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=28424"},"modified":"2025-07-20T07:18:32","modified_gmt":"2025-07-19T23:18:32","slug":"clin-infect-dis%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%ce%b2-%e5%86%85%e9%85%b0%e8%83%ba%e6%8a%97%e7%94%9f%e7%b4%a0%e4%b8%8e%e4%b8%87%e5%8f%a4%e9%9c%89%e7%b4%a0%e7%94%a8%e8%8d%af%e6%ac%a1","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=28424","title":{"rendered":"[Clin Infect Dis\u53d1\u8868\u8bba\u6587]\uff1a\u03b2-\u5185\u9170\u80fa\u6297\u751f\u7d20\u4e0e\u4e07\u53e4\u9709\u7d20\u7528\u836f\u6b21\u5e8f\u4e0e\u7591\u4f3c\u8113\u6bd2\u75c7\u60a3\u8005\u75c5\u6b7b\u7387\u7684\u76f8\u5173\u6027"},"content":{"rendered":"\n

JOURNAL ARTICLE EDITOR'S CHOICE<\/a><\/p>\n\n\n\n

Association Between the Sequence of \u03b2-Lactam and Vancomycin Administration and Mortality in Patients With Suspected Sepsis<\/em><\/h1>\n\n\n\n

Yutaka Kondo, Michael Klompas, Caroline S McKenna, et al<\/h3>\n\n\n\n

Clin Infect Dis<\/em> 2025; 80: 761-769<\/h3>\n\n\n\n

https:\/\/doi.org\/10.1093\/cid\/ciae599<\/a><\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Background<\/p>\n\n\n\n

Timely antibiotic initiation is critical to sepsis management, but there are limited data on the impact of giving \u03b2-lactams first versus vancomycin first among patients prescribed both agents.<\/p>\n\n\n\n

Methods<\/p>\n\n\n\n

We retrospectively analyzed all adults admitted to 5 US hospitals from 2015\u20132022 with suspected sepsis (blood culture collected, antibiotics administered, and organ dysfunction) treated with vancomycin and a broad-spectrum \u03b2-lactam within 24\u2005hours of arrival. We estimated associations between \u03b2-lactam- versus vancomycin-first strategies and in-hospital mortality using inverse probability weighting (IPW) to adjust for potential confounders.<\/p>\n\n\n\n

Results<\/p>\n\n\n\n

Among 25 391 patients with suspected sepsis, 21 449 (84.4%) received \u03b2-lactams first and 3942 (15.6%) received vancomycin first. Compared with the \u03b2-lactam-first group, patients administered vancomycin first tended to be less severely ill, had more skin\/musculoskeletal infections (20.0% vs 7.8%), and received \u03b2-lactams a median of 3.5\u2005hours later relative to emergency department arrival. On IPW analysis, the \u03b2-lactam-first strategy was associated with lower mortality (adjusted odds ratio [aOR]: .89; 95% CI: .80\u2013.99). Point estimates were directionally similar but nonsignificant in a sensitivity analysis using propensity score matching rather than IPW (aOR: .94; 95% CI: .82\u20131.07) and in subgroups of patients with positive blood cultures, methicillin-resistant\u00a0Staphylococcus aureus<\/em>\u00a0cultures, and those administered antipseudomonal \u03b2-lactams.<\/p>\n\n\n\n

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Conclusions<\/p>\n\n\n\n

Among patients with suspected sepsis prescribed vancomycin and \u03b2-lactam therapy, \u03b2-lactam administration before vancomycin was associated with a modest reduction in in-hospital mortality. These findings support prioritizing \u03b2-lactam therapy in most patients with sepsis but merit confirmation in randomized trials given the risk of residual confounding in observational analyses.<\/p>\n","protected":false},"excerpt":{"rendered":"

JOURNAL ARTICLE EDITOR’S CHOICE Association Betwee […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28424"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28424"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28424\/revisions"}],"predecessor-version":[{"id":28711,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28424\/revisions\/28711"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28424"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=28424"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=28424"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}