Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy

David D Leedahl,Rahul Kashyap,Heather A Personett,Ognjen Gajic,Garrett E Schramm

doi:10.1186/1471-2253-14-21

David D Leedahl, Rahul Kashyap + Show 3 more

Open Access

https://doi.org/10.1186/1471-2253-14-21

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Journal: BMC anesthesiology	Publication Date: Mar 25, 2014
Citations: 32	License type: cc-by

Affiliation: Sanford Medical Center, Mayo Clinic

Abstract

BackgroundFactors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care.MethodsWe conducted a secondary subgroup analysis of a prospective severe sepsis cohort study. Patients with septic shock and positive blood cultures who received appropriate antimicrobial therapy were included. Univariable analyses were used to identify differences between hospital survivors and non-survivors, and a multivariable logistic regression model revealed independent determinants of hospital mortality.ResultsFrom January 2008 to December 2010, 58 of 224 included patients died in the hospital. Multivariable logistic regression analysis demonstrated 2 independent predictors of hospital mortality. These included continuous renal replacement therapy utilization within 48 hours of septic shock recognition (adjusted odds ratio [OR], 5.52; 95% confidence interval [CI], 1.94-16.34) and intra-abdominal infection (adjusted OR, 3.92; 95% CI, 1.47-10.79). Escherichia coli was independently associated with a lower risk of hospital mortality (adjusted OR, 0.34; 95% CI, 0.11-0.90).ConclusionIntra-abdominal infection and continuous renal replacement therapy were associated with increased hospital mortality in patients with septic shock who received appropriate antimicrobial therapy. Our findings may be explained by suboptimal intra-abdominal infection management or inadequate antimicrobial concentration in these patients.

Highlights

Factors capable of impacting hospital mortality in patients with septic shock remain uncertain
We hypothesized that independent risk factors for hospital mortality exist in bacteremic patients with septic shock who received appropriate antimicrobial therapy while accounting for Acute Physiology and Chronic Health Evaluation (APACHE) III score, preference of care, and processes of care, including compliance with non-antimicrobial elements of our sepsis resuscitation bundle
APACHE III score was the only baseline characteristic statistically associated with hospital mortality by univariable analysis (Table 1)

Summary

Introduction

Factors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care. Within the septic shock treatment armamentarium, a directed approach that includes both appropriate and timely antimicrobial therapy continues to be a cornerstone of treatment, with ample. Prompt administration of appropriate antimicrobial therapy may improve hospital survival, predictors of mortality in bacteremic septic shock remain largely unknown when appropriate antimicrobials are administered [9]. We hypothesized that independent risk factors for hospital mortality exist in bacteremic patients with septic shock who received appropriate antimicrobial therapy while accounting for Acute Physiology and Chronic Health Evaluation (APACHE) III score, preference of care, and processes of care, including compliance with non-antimicrobial elements of our sepsis resuscitation bundle

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