Chest
Original ResearchCritical Care MedicineInitiation of Inappropriate Antimicrobial Therapy Results in a Fivefold Reduction of Survival in Human Septic Shock
Section snippets
Materials and Methods
A retrospective review of adult patients (ā„ 18 years of age) who had received a diagnosis of septic shock was performed. A waived consent protocol was approved by the health ethics boards of the University of Manitoba and at each individual participating center. Consecutive adult patients with septic shock from 22 medical institutions from Canada (17 sites), the United States (4 sites), and Saudi Arabia (1 site) were collected from discrete periods between 1996 and 2005. Each institution
Demographic and Descriptive Data
In total, 5,715 cases were found to fit the diagnostic criteria for septic shock. The mean age of case patients with septic shock was 62.6 Ā± 16.3 years, with 56.3% male patients and 43.7% female patients. The mean acute physiology and chronic health evaluation (APACHE) II score32 determined from the most abnormal results within 24 h of shock onset was 25.2 Ā± 9.7. Treatment with drotrecogin-alfa (activated)33 was used in 124 cases (outside of randomized trials), while low-dose steroid therapy
Discussion
These data suggest that the provision of inappropriate initial empiric antimicrobial therapy has a very substantial adverse effect on survival in patients with septic shock and that this effect is present across all major clinical subgroups. Further, the study confirms that the occurrence of the initiation of organism-inappropriate empiric therapy is surprisingly common.
The degree to which the administration of inappropriate initial empiric therapy adversely affected survival in the study group
Acknowledgments
Author contributions: Study design: Dr. Anand Kumar. Data collection: members of the Cooperative Antimicrobial Therapy of Septic Shock Database Research Group. Data analysis and interpretation: Drs. Anand Kumar and Chateau. Manuscript development: Drs. Anand Kumar, Ellis, Arabi, Roberts, Light, Parrillo, Dodek, Wood, Aseem Kumar, Ahsan, and Simon, and Ms. Peters. Dr. Anand Kumar had full access to all of the data in the study, and takes responsibility for the integrity of the data and the
References (0)
Cited by (910)
Real-time, label-free detection and identification of bacteria through non-invasive optical imaging
2024, Microbes and InfectionEvaluation of the feasibility of EUCAST RAST using antimicrobial disks available in Japan
2023, Journal of Infection and Chemotherapy
Funding/Support: Astellas Pharma Inc, Eli-Lilly and Co, Pfizer Inc, Bayer Inc, Merck and Co, Wyeth Pharmaceuticals, Bristol-Myers Squibb Co, and Astra-Zeneca, Inc, provided unrestricted grants in support of this study. Additional support was provided by the Health Sciences Centre Department of Research and Health Sciences Centre Foundation.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
- *
A complete list of participants is located in Appendix 3.