Keith A Corl1, Fatima Zeba2, Aisling R Caffrey, Matthew Hermenau3, Vrishali Lopes3, Gary Phillips4, Roland C Merchant5,6, Mitchell M Levy1, Kerry L LaPlante3,7,8. 1. Division of Pulmonary Critical Care and Sleep, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI. 2. Department of Medicine Kent Hospital, Alpert Medical School of Brown University, Warwick, RI. 3. Veterans Affairs Medical Center, Infectious Diseases Research Program and Center of Innovation in Long Term Services and Supports, Providence, RI. 4. Consultant retired from the Center for Biostatistics, Department of Biomedical Informatics, Ohio State University, Columbus, OH. 5. Brown University School of Public Health, Providence, RI. 6. Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 7. University of Rhode Island College of Pharmacy, Kingston, RI. 8. Division of Infectious Disease, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
Abstract
OBJECTIVES: The relationship between the timing of antibiotics and mortality among septic shock patients has not been examined among patients specifically with Staphylococcus aureus bacteremia. DESIGN: Retrospective analysis of a Veterans Affairs S. aureus bacteremia database. SETTING: One-hundred twenty-two hospitals in the Veterans Affairs Health System. PATIENTS: Patients with septic shock and S. aureus bacteremia admitted directly from the emergency department to the ICU from January 1, 2003, to October 1, 2015, were evaluated. INTERVENTIONS: Time to appropriate antibiotic administration and 30-day mortality. MEASUREMENTS AND MAIN RESULTS: A total of 506 patients with S. aureus bacteremia and septic shock were included in the analysis. Thirty-day mortality was 78.1% for the entire cohort and was similar for those participants with methicillin-resistant S. aureus and methicillin-sensitive S. aureus bacteremia. Our multivariate analysis revealed that, as compared with those who received appropriate antibiotics within 1 hour after emergency department presentation, each additional hour that passed before appropriate antibiotics were administered produced an odds ratio of 1.11 (95% CI, 1.02-1.21) of mortality within 30 days. This odds increase equates to an average adjusted mortality increase of 1.3% (95% CI, 0.4-2.2%) for every hour that passes before antibiotics are administered. CONCLUSIONS: The results of this study further support the importance of prompt appropriate antibiotic administration for patients with septic shock. Physicians should consider acting quickly to administer antibiotics with S. aureus coverage to any patient suspected of having septic shock.
OBJECTIVES: The relationship between the timing of antibiotics and mortality among septic shockpatients has not been examined among patients specifically with Staphylococcus aureus bacteremia. DESIGN: Retrospective analysis of a Veterans Affairs S. aureus bacteremia database. SETTING: One-hundred twenty-two hospitals in the Veterans Affairs Health System. PATIENTS: Patients with septic shock and S. aureus bacteremia admitted directly from the emergency department to the ICU from January 1, 2003, to October 1, 2015, were evaluated. INTERVENTIONS: Time to appropriate antibiotic administration and 30-day mortality. MEASUREMENTS AND MAIN RESULTS: A total of 506 patients with S. aureus bacteremia and septic shock were included in the analysis. Thirty-day mortality was 78.1% for the entire cohort and was similar for those participants with methicillin-resistant S. aureus and methicillin-sensitive S. aureus bacteremia. Our multivariate analysis revealed that, as compared with those who received appropriate antibiotics within 1 hour after emergency department presentation, each additional hour that passed before appropriate antibiotics were administered produced an odds ratio of 1.11 (95% CI, 1.02-1.21) of mortality within 30 days. This odds increase equates to an average adjusted mortality increase of 1.3% (95% CI, 0.4-2.2%) for every hour that passes before antibiotics are administered. CONCLUSIONS: The results of this study further support the importance of prompt appropriate antibiotic administration for patients with septic shock. Physicians should consider acting quickly to administer antibiotics with S. aureus coverage to any patient suspected of having septic shock.
Authors: Alexander H Flannery; Katie L Wallace; Christian N Rhudy; Allison S Olmsted; Rachel C Minrath; Stuart M Pope; Aaron M Cook; David S Burgess; Peter E Morris Journal: Ther Adv Infect Dis Date: 2021-03-30
Authors: Stephen W Tuffs; Mariya I Goncheva; Stacey X Xu; Heather C Craig; Katherine J Kasper; Joshua Choi; Ronald S Flannagan; Steven M Kerfoot; David E Heinrichs; John K McCormick Journal: Proc Natl Acad Sci U S A Date: 2022-02-22 Impact factor: 12.779