Impact of inappropriate empiric antimicrobial therapy on mortality of septic patients with bacteremia: a retrospective study

Leuangarun, S.; Leelarasamee, Amorn

doi:10.1016/j.ijid.2012.05.631

Cited by 15 publications

(25 citation statements)

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“…Empirical antimicrobial therapy was proved to be inappropriate among 46% of patient recorded in our study with a high mortality rate of 82.6%. While those with appropriate antimicrobial therapy (54%), mortality rate was less (55.5%), this finding is identical to a study done in Thailand in 2012 [35]. Following blood culture results the antimicrobial therapy were changed in some patients which resulted with lower mortality rate of 58.6%, compared with 80% mortality if the antibiotics were not changed, a study done in Indonesia in 2013 revealed that appropriate empirical antibiotic has better result in outcome for septic patients [36].…”

Section: Discussionsupporting

confidence: 85%

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Ahmad¹,

Ismaeel

Mohammed

et al. 2018

KJAR

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Sepsis is a very common condition in emergency hospitals and presentation is variable, it is under diagnosed with very high mortality rate. All patients with infection are at risk of developing sepsis. Sepsis is a complex condition characterized by activation of inflammatory process and coagulation system in response to microbial insult. An observational prospective study was carried out at RozhHalat emergency hospital in Erbil-Kurdistan region of Iraq between February 2017 to January 2018.The study was approved by the scientific and ethical committee of Kurdistan board of medical specialties. 50 patients aged between (10 -80) years old presented to this hospital with sign and symptoms of infection were recruited to this study. 50 patients with signs and symptoms of sepsis were recorded in this study. The mean age was 47 with male to female ration of 2:3 (42% male and 58% female). The overall mortality rate was high at 68% with higher rate among female and older age group. The blood culture was positive in 74% of cases of which 52% were gram positive and 22% were gram-negative microorganisms. A Positive blood culture associated with higher mortality rate of 81% compared with 21% if the blood culture was negative. In majority of cases the site of infection was from multiple source (34%) followed by respiratory infection (26%).Skin and soft tissue infection was associated with the lowest mortality of 2.9%. High number of cases (82%) developed complications and 52% of cases developed more than 2 organ failures. All patients received empirical antibiotic therapy however 46% of cases received the wrong antimicrobials. The survival rate was higher (44%) among patients given the right antibiotics. Similarly patients had better chance of survival if appropriate fluid resuscitation therapy was give. The overall mortality among vasopressor treated patients were 72% compared with 78% chance of mortality if they were not treated with any vasopressor therapy, among those who received inotropic supportNoradrenaline associated with higher survival rate(72%). A qSOFA score of more than 2 associated with 86.4 % of mortality compared with 75.5% mortality with similar SIRS criteria. Factors associated with high mortality were: female gender, older age group, positive blood culture, wrong antibiotics therapy, less fluid resuscitation, multisource of infection, multi-organ failure, high lactic acid level and high qSOFA score. This study shows that sepsis is associated with high overall mortality rate of 68% in the RozhHalat emergency hospital and higher rate of death among female and older age group. Negative blood culture, appropriate use of antibiotics and fluid therapy associated with better chance of survival. Vasopressor therapy did not result in better survival outcome except for Noradrenaline. The qSOFA score is as good as SIRS criteria in predicting mortality. High lactate, multi-organ failure and multisource of infection associated with the worst outcome.

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Section: Discussionsupporting

confidence: 85%

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Ahmad¹,

Ismaeel

Mohammed

et al. 2018

KJAR

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“…5 One study examined the impact of inappropriate first-dose antimicrobial selection and delayed antimicrobial administration on the mortality of septic patients with bacteremia and found an increased mortality rate with both factors. 11 In this study, inappropriate initial therapy selection had a significant impact on health careeassociated and hospital-acquired infections for 42.6% of patients (n ¼ 29), with the greatest inappropriate selection reported for genitourinary site infections (27.9%; n ¼ 20). 11 Based on these findings, risk factors for drug-resistant organisms and local antimicrobial susceptibility patterns should be considered when selecting empiric regimens.…”

mentioning

confidence: 72%

“…11 In this study, inappropriate initial therapy selection had a significant impact on health careeassociated and hospital-acquired infections for 42.6% of patients (n ¼ 29), with the greatest inappropriate selection reported for genitourinary site infections (27.9%; n ¼ 20). 11 Based on these findings, risk factors for drug-resistant organisms and local antimicrobial susceptibility patterns should be considered when selecting empiric regimens.…”

mentioning

confidence: 72%

Development of a urinary-specific antibiogram for gram-negative isolates: Impact of patient risk factors on susceptibility

Rabs

Wieczorkiewicz

Costello³

et al. 2014

American Journal of Infection Control

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“…52,[61][62][63][64][65][66] Delays are only inconsistently associated with mortality in bacteremia/candidemia and sepsis without shock. [67][68][69][70][71] One major retrospective analysis of septic shock suggested that the delay in initial administration of effective antimicrobial therapy is the single strongest predictor of survival. 72 Every hour of delay in appropriate antimicrobial administration, in the first 6 hours after hypotension is documented, decreases survival by 7.6%.…”

Section: Antimicrobial Delaymentioning

confidence: 99%

Optimizing Antimicrobial Therapy of Sepsis and Septic Shock: Focus on Antibiotic Combination Therapy

Vázquez-Grande

Kumar

2015

Semin Respir Crit Care Med

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Severe sepsis and septic shock with sepsis-associated multiple organ failure represent the major causes of infection-associated mortality and remain the most common cause of death in intensive care units (ICUs) of developed countries. They account for 10 to 15% of all ICU admissions and 25% of sepsis cases 1 ; up to 50 to 75% of severe sepsis cases progress to septic shock. 2 Septic shock alone represents 5 to 8% of all ICU admissions. 3 Historically, the mortality associated with sepsis and septic shock has been 50 to 75%. [4][5][6] This decreased after the development of modern antimicrobial therapies, starting with penicillin in the early 1940s. Since then sepsis-associated mortality has fallen to the 30 to 50% range. 4,5 Since the development of modern antimicrobials, bacterial pathogens have continuously evolved under their selective pressure. There has also been a gradual increase in the incidence of sepsis over the intervening decades. 7 Current estimates suggest a doubling of total cases of severe sepsis in United States by 2050 (from the actual 800,000 cases per year AbstractThere has been little improvement in septic shock mortality in the past 70 years, despite ever more broad-spectrum and potent antimicrobials. In the past, resuscitative elements have been the primary area of clinical septic shock management and research. The question of the optimal use of antimicrobial therapy was relatively ignored in recent decades. This review explores the pathophysiology of sepsis in an attempt to produce a better understanding and define key determinants of antimicrobial therapy response in septic shock. Optimizing existing antimicrobials delivery can drive significant improvements in the outcome of sepsis and septic shock. Inappropriate antimicrobial selection and dosing or delays in the administration substantially increase mortality and morbidity in life-threatening infections. Definitive combination therapy (where a pathogen known to be susceptible to a given agent is additionally covered by another agent) remains controversial. Although some in vitro studies, animal models, and clinical studies of infection including endocarditis, gram-negative bacteremia, and neutropenic infections have supported combination therapy, the potential clinical benefit in other severe infections has been questioned. Several meta-analyses have failed to demonstrate improvement of outcome with combination therapy in immunocompetent patients with sepsis and/or gram-negative bacteremia. These meta-analyses did not undertake subgroup analyses of the septic shock population. This article reviews the existing evidence supporting combination therapy for severe infections, sepsis, and septic shock.

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Impact of inappropriate empiric antimicrobial therapy on mortality of septic patients with bacteremia: a retrospective study

Cited by 15 publications

References 0 publications

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Development of a urinary-specific antibiogram for gram-negative isolates: Impact of patient risk factors on susceptibility

Optimizing Antimicrobial Therapy of Sepsis and Septic Shock: Focus on Antibiotic Combination Therapy

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