Abstract
BackgroundChoice of empirically prescribed antimicrobials for sepsis management depends on epidemiological factors. The epidemiology of sepsis in Greece was studied in two large-periods.MethodsSepsis due to bloodstream infections (BSI) from July 2006 until March 2013 was recorded in a multicenter study in 46 departments. Patients were divided into sepsis admitted in the emergencies and hospitalized in the general ward (GW) and sepsis developing after admission in the Intensive Care Unit (ICU). The primary endpoints were the changes of epidemiology and the factors related with BSIs by multidrug-resistant (MDR) pathogens; the secondary endpoint was the impact of de-escalation on antimicrobial therapy.Results754 patients were studied; 378 from 2006–2009 and 376 from 2010–2013. Major differences were recorded between periods in the GW. They involved increase of: sepsis severity; the incidence of underlying diseases; the incidence of polymicrobial infections; the emergence of Klebsiella pneumoniae as a pathogen; and mortality. Factors independently related with BSI by MDR pathogens were chronic hemofiltration, intake of antibiotics the last three months and residence into long-term care facilities. De-escalation in BSIs by fully susceptible Gram-negatives did not affect final outcome. Similar epidemiological differences were not found in the ICU; MDR Gram-negatives predominated in both periods.ConclusionsThe epidemiology of sepsis in Greece differs in the GW and in the ICU. De-escalation in the GW is a safe strategy.
Highlights
Choice of empirically prescribed antimicrobials for sepsis management depends on epidemiological factors
Bloodstream infections (BSIs) are a significant cause of mortality especially if they are manifested with signs of sepsis and septic shock [1, 2]
Patients with communityacquired sepsis admitted to the general ward or with hospital-acquired sepsis developing in the Intensive Care Unit (ICU) at least 48 hours after ICU admission are enrolled in this study
Summary
Choice of empirically prescribed antimicrobials for sepsis management depends on epidemiological factors. One of the strategies recommended to avoid selection of MDR isolates is antibiotic de-escalation [7] This strategy includes either switching to a narrower spectrum antimicrobial when the antibiogram is available or reducing the number of antibiotics used. The application of this strategy is limited with a rate varying between 22 and 74% of cases when this concerns patients with ventilatorassociated pneumonia (VAP) [8,9,10]
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