Abstract
IntroductionWe aimed to establish whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during evolving bacterial community-acquired infection in adults is associated with severe sepsis or septic shock.MethodsWe conducted a multicentre case-control study in eight intensive care units. Cases were all adult patients admitted for severe sepsis or septic shock due to a bacterial community-acquired infection. Control individuals were patients hospitalized with a mild community-acquired infection. Each case was matched to one control for age, presence of diabetes and site of infection.ResultsThe main outcome measures were the proportions of cases and controls exposed to NSAIDs or aspirin during the period of observation. In all, 152 matched pairs were analyzed. The use of NSAIDs or aspirin during the observation period did not differ between cases and controls (27% versus 28; odds ratio = 0.93, 95% confidence interval [CI] = 0.52 to 1.64). If aspirin was not considered or if a distinction was made between acute and chronic drug treatment, there remained no difference between groups. However, the median time to prescription of effective antibiotic therapy was longer for NSAID users (6 days, 95% CI = 3 to 7 days) than for nonusers (3 days, 95% CI = 2 to 3 days; P = 0.02).ConclusionsIn this study, the use of NSAIDs or aspirin during evolving bacterial infection was frequent and occurred in one-quarter of the patients with such infection. Although the use of NSAIDs by patients with severe sepsis or septic shock did not differ from their use by those with mild infection at the same infected site, we observed a longer median time to prescription of effective antibiotic therapy in NSAID users.
Highlights
We aimed to establish whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during evolving bacterial community-acquired infection in adults is associated with severe sepsis or septic shock
The use of NSAIDs by patients with severe sepsis or septic shock did not differ from their use by those with mild infection at the same infected site, we observed a longer median time to prescription of effective antibiotic therapy in NSAID users
The use of NSAIDs or aspirin during the observation period did not differ between cases and controls (27% versus 28; odds ratio (OR) = 0.93, 95% confidence intervals (CIs) = 0.52 to 1.64; P = 0.79; Table 2)
Summary
We aimed to establish whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during evolving bacterial community-acquired infection in adults is associated with severe sepsis or septic shock. Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are widely used as antipyretic or analgesic drugs, even during evolving bacterial infections. CI: confidence interval; ICU: intensive care unit; NSAID: nonsteroidal anti-inflammatory drug; OR: odds ratio. Cerning patients admitted to intensive care units (ICUs) have suggested that the use of NSAIDs increases the severity of bacterial infections and may lead to shock and multiple organ failure [7,8,9,10]. In the present study we investigated whether exposure to NSAIDs or aspirin affects the evolution of bacterial infection
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