OBJECTIVES: We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections. DESIGN: We used a prospective observational cohort 10-yr database. We built a subdistribution hazards model with corrections for competing risks and adjustment for potential confounders including early appropriate antimicrobial therapy. SETTING: Twelve intensive care units. PATIENTS: We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 1562 community-acquired, 1432 hospital-acquired, and 1012 intensive care unit-acquired episodes of severe sepsis. After adjustment, we found no independent associations of the causative organism, multidrug resistance of the causative organism, infection site, or presence of bacteremia with mortality. Early appropriate antimicrobial therapy was consistently associated with better survival in the community-acquired (0.64 [0.51-0.8], p = .0001), hospital-acquired (0.72 [0.58-0.88], p = .0011), and intensive care unit-acquired (0.79 [0.64-0.97], p = .0272) groups. CONCLUSION: The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.
OBJECTIVES: We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections. DESIGN: We used a prospective observational cohort 10-yr database. We built a subdistribution hazards model with corrections for competing risks and adjustment for potential confounders including early appropriate antimicrobial therapy. SETTING: Twelve intensive care units. PATIENTS: We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 1562 community-acquired, 1432 hospital-acquired, and 1012 intensive care unit-acquired episodes of severe sepsis. After adjustment, we found no independent associations of the causative organism, multidrug resistance of the causative organism, infection site, or presence of bacteremia with mortality. Early appropriate antimicrobial therapy was consistently associated with better survival in the community-acquired (0.64 [0.51-0.8], p = .0001), hospital-acquired (0.72 [0.58-0.88], p = .0011), and intensive care unit-acquired (0.79 [0.64-0.97], p = .0272) groups. CONCLUSION: The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.
Authors: William O Hahn; Carmen Mikacenic; Brenda L Price; Susanna Harju-Baker; Ronit Katz; Jonathan Himmelfarb; Mark M Wurfel; W Conrad Liles Journal: Virulence Date: 2016-01-28 Impact factor: 5.882
Authors: Manu Shankar-Hari; Gary S Phillips; Mitchell L Levy; Christopher W Seymour; Vincent X Liu; Clifford S Deutschman; Derek C Angus; Gordon D Rubenfeld; Mervyn Singer Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: Xuan Han; Dana P Edelson; Ashley Snyder; Natasha Pettit; Sarah Sokol; Carmen Barc; Michael D Howell; Matthew M Churpek Journal: Chest Date: 2018-05-24 Impact factor: 9.410
Authors: Yoon Hee Kim; Hyun Bin Park; Min Jung Kim; Hwan Soo Kim; Hee Seon Lee; Yoon Ki Han; Kyung Won Kim; Myung Hyun Sohn; Kyu-Earn Kim Journal: J Korean Med Sci Date: 2013-01-08 Impact factor: 2.153