Inappropriate Sepsis Therapy Leads to Reduced Survival

Researchers at the University of Manitoba (Winnipeg, MB, Canada), King Saud Bin Abdulaziz University for Health Sciences (Riyadh, Saudi Arabia), and other institutions retrospectively reviewed 5,715 patients in three countries with septic shock to determine the appropriateness of initial antimicrobial therapy, clinical infection site, and relevant pathogens. The study results showed that inappropriate initial antimicrobial therapy occurred in 20% of patients, with overall survival at 43.7%; survival after appropriate and inappropriate initial therapy, respectively, was 52% and 10.3%. Furthermore, the decrease in survival with inappropriate initial therapy ranged from a 2.3-fold decrease for pneumococcal infection to a 17.6-fold decrease with primary bacteremia. After adjustment for acute physiology and chronic health evaluation II score, comorbidities, hospital site, and other potential risk factors, the inappropriateness of initial antimicrobial therapy remained most highly associated with risk of death. The study was published in the November 2009 issue of Chest.

"Inappropriate initial antimicrobial therapy for septic shock occurs in about 20% of patients and is associated with a fivefold reduction in survival,” concluded lead author Anand Kumar, M.D., of the section of critical care medicine at the University of Manitoba, and colleagues. "Efforts to increase the frequency of the appropriateness of initial antimicrobial therapy must be central to efforts to reduce the mortality of patients with septic shock.”

A problem in the adequate management of septic patients is the delay in administering therapy after sepsis has been recognized. Published studies have demonstrated that for every hour of delay in the administration of appropriate antibiotic therapy there is an associated 7% rise in mortality. A large international collaboration has been established to educate people about sepsis and to improve patient outcomes with sepsis, entitled the Surviving Sepsis Campaign. The campaign has published an evidence-based review of management strategies for severe sepsis, with the aim of eventually publishing a complete set of guidelines.

Related Links:
University of Manitoba

King Saud Bin Abdulaziz University for Health Sciences

Surviving Sepsis Campaign