OBJECTIVE: To assess the adequacy of empirical antimicrobial therapy prescribed in septic shock patients and to evaluate the relationship between inadequate antimicrobial therapy and 30-day mortality. DESIGN: Prospective observational study. SETTING: Medical-surgical (16-bed) intensive care unit in an urban teaching hospital. PATIENTS: A total of 107 patients requiring intensive care admission were prospectively evaluated during the 3-yr period of the study. INTERVENTIONS: Prospective patient surveillance and data collection and assessment of antimicrobial therapy according to microbiological documentation. MEASUREMENTS AND MAIN RESULTS: A source of infection associated with a microbiological documentation was identified in 78 of the 107 patients (72%). Empirical antimicrobial therapy consisted of a pivotal antibiotic (beta-lactam) associated with an aminoglycoside (59 patients) or a fluoroquinolone (21 patients). Vancomycin was added in 14 patients. Sixty-nine of the 78 patients (89%) received an adequate antimicrobial therapy. The mortality rate of patients receiving an adequate antimicrobial therapy was 56%, and seven of the nine patients (78%) receiving an inadequate antimicrobial therapy died (p =.2). Among the 81 patients who were alive on day 3, antimicrobial therapy was modified in agreement to clinical status and microbiological documentation in 80% of cases, with de-escalation in 64% of cases. De-escalation consisted of withdrawing the nonpivotal antibiotic in 42% of patients or switching to a narrow-spectrum beta-lactam antibiotic (22% of cases). CONCLUSION: The prescription of empirical antimicrobial therapy by a senior physician in agreement with practice guidelines made it possible to achieve a crude rate of 89% of adequate antimicrobial therapy in study patients. Inadequate antimicrobial therapy was associated with a 39% excess of mortality. A de-escalation of the empirical therapy was possible in 64% of patients.
OBJECTIVE: To assess the adequacy of empirical antimicrobial therapy prescribed in septic shockpatients and to evaluate the relationship between inadequate antimicrobial therapy and 30-day mortality. DESIGN: Prospective observational study. SETTING: Medical-surgical (16-bed) intensive care unit in an urban teaching hospital. PATIENTS: A total of 107 patients requiring intensive care admission were prospectively evaluated during the 3-yr period of the study. INTERVENTIONS: Prospective patient surveillance and data collection and assessment of antimicrobial therapy according to microbiological documentation. MEASUREMENTS AND MAIN RESULTS: A source of infection associated with a microbiological documentation was identified in 78 of the 107 patients (72%). Empirical antimicrobial therapy consisted of a pivotal antibiotic (beta-lactam) associated with an aminoglycoside (59 patients) or a fluoroquinolone (21 patients). Vancomycin was added in 14 patients. Sixty-nine of the 78 patients (89%) received an adequate antimicrobial therapy. The mortality rate of patients receiving an adequate antimicrobial therapy was 56%, and seven of the nine patients (78%) receiving an inadequate antimicrobial therapy died (p =.2). Among the 81 patients who were alive on day 3, antimicrobial therapy was modified in agreement to clinical status and microbiological documentation in 80% of cases, with de-escalation in 64% of cases. De-escalation consisted of withdrawing the nonpivotal antibiotic in 42% of patients or switching to a narrow-spectrum beta-lactam antibiotic (22% of cases). CONCLUSION: The prescription of empirical antimicrobial therapy by a senior physician in agreement with practice guidelines made it possible to achieve a crude rate of 89% of adequate antimicrobial therapy in study patients. Inadequate antimicrobial therapy was associated with a 39% excess of mortality. A de-escalation of the empirical therapy was possible in 64% of patients.
Authors: J Garnacho-Montero; A Gutiérrez-Pizarraya; A Escoresca-Ortega; Y Corcia-Palomo; Esperanza Fernández-Delgado; I Herrera-Melero; C Ortiz-Leyba; J A Márquez-Vácaro Journal: Intensive Care Med Date: 2013-09-12 Impact factor: 17.440
Authors: Y Maaloum; A Meybeck; D Olive; N Boussekey; P-Y Delannoy; A Chiche; H Georges; E Beltrand; E Senneville; T d'Escrivan; O Leroy Journal: Infection Date: 2012-10-25 Impact factor: 3.553
Authors: Marc Leone; Carole Bechis; Karine Baumstarck; Jean-Yves Lefrant; Jacques Albanèse; Samir Jaber; Alain Lepape; Jean-Michel Constantin; Laurent Papazian; Nicolas Bruder; Bernard Allaouchiche; Karine Bézulier; François Antonini; Julien Textoris; Claude Martin Journal: Intensive Care Med Date: 2014-08-05 Impact factor: 17.440
Authors: K Reinhart; F Brunkhorst; H Bone; H Gerlach; M Gründling; G Kreymann; P Kujath; G Marggraf; K Mayer; A Meier-Hellmann; C Peckelsen; C Putensen; M Quintel; M Ragaller; R Rossaint; F Stüber; N Weiler; T Welte; K Werdan Journal: Internist (Berl) Date: 2006-04 Impact factor: 0.743