Adequate antibiotic therapy prior to ICU admission in patients with severe sepsis and septic shock reduces hospital mortality.

José Garnacho-Montero,Antonio Gutiérrez-Pizarraya,Esperanza Fernández-Delgado,Ana Escoresca-Ortega,José María López-Sánchez

doi:10.1186/s13054-015-1000-z

Abstract

IntroductionIn patients with severe sepsis and septic shock as cause of Intensive Care Unit (ICU) admission, we analyze the impact on mortality of adequate antimicrobial therapy initiated before ICU admission.MethodsWe conducted a prospective observational study enrolling patients admitted to the ICU with severe sepsis or septic shock from January 2008 to September 2013. The primary end-point was in-hospital mortality. We considered two groups for comparisons: patients who received adequate antibiotic treatment before or after the admission to the ICU.ResultsA total of 926 septic patients were admitted to ICU, and 638 (68.8%) had available microbiological isolation: 444 (69.6%) received adequate empirical antimicrobial treatment prior to ICU and 194 (30.4%) after admission. Global hospital mortality in patients that received treatment before ICU admission, between 0-6h ICU, 6–12h ICU, 12–24h ICU and after 24 hours since ICU admission were 31.3, 53.2, 57.1, 50 and 50.8% (p<0.001). The multivariate analysis showed that urinary focus (odds ratio (OR) 0.20; 0.09–0.42; p<0.001) and adequate treatment prior to ICU admission (OR 0.37; 0.24–0.56; p<0.001) were protective factors whereas APACHE II score (OR 1.10; 1.07–1.14; p<0.001), septic shock (OR 2.47; 1.57–3.87; p<0.001), respiratory source (OR 1.91; 1.12–3.21; p=0.016), cirrhosis (OR 3.74; 1.60–8.76; p=0.002) and malignancy (OR 1.65; 1.02–2.70; p=0.042) were variables independently associated with in-hospital mortality. Adequate treatment prior to ICU was a protective factor for mortality in patients with severe sepsis (n=236) or in septic shock (n=402).ConclusionsThe administration of adequate antimicrobial therapy before ICU admission is decisive for the survival of patients with severe sepsis and septic shock. Our efforts should be directed to assure the correct administration antibiotics before ICU admission in patients with sepsis.

Highlights

In patients with severe sepsis and septic shock as cause of Intensive Care Unit (ICU) admission, we analyze the impact on mortality of adequate antimicrobial therapy initiated before ICU admission
Our aim is to analyze the impact on mortality of receiving adequate antimicrobial therapy before ICU admission compared with patients treated correctly after ICU admittance, in a cohort of patients admitted to the ICU for severe sepsis or septic shock
We have demonstrated that the initiation of effective antimicrobial therapy before ICU admission is a critical determinant of outcome in patients with severe sepsis and septic shock

Summary

Introduction

In patients with severe sepsis and septic shock as cause of Intensive Care Unit (ICU) admission, we analyze the impact on mortality of adequate antimicrobial therapy initiated before ICU admission. Acute management of patients with severe sepsis and septic shock is a very frequent task for ICU physicians. This management includes hemodynamic support and the administration of adequate antibiotics. Antibiotic administration is associated with decreased morbidity and mortality in critically ill patients. It is noteworthy that acquisition of the infection before ICU admission has been identified as independently associated with early death in a large cohort of patients with sepsis [8]. The first antibiotic doses are usually administered outside the ICU when culture results are not yet available [9]

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