Outcomes in severe sepsis and patients with septic shock: Pathogen species and infection sites are not associated with mortality*

Zahar, Jean‐Ralph; Timsit, Jean‐François; Garrouste-Orgeas, Maïté; Français, Adrien; Vesin, Aurélien; Vesim, Aurélien; Descorps-Declère, A.; Dubois, Yohann; Souweine, Bertrand; Haouache, Hakim; Goldgran-Tolédano, Dany; Allaouchiche, Bernard; Azoulay, Élie; Adrie, Christophe

doi:10.1097/ccm.0b013e31821b827c

Cited by 227 publications

(195 citation statements)

References 39 publications

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“…Bacterial resistance was also associated with mortality in recent, large, well-conducted epidemiological studies [2,25]. However, when both bacterial resistance and adequacy of treatment are taken into account, treatment inadequacy is seen to make a larger contribution to the mortality increase than bacterial resistance [9,26,27]. One major finding from our study is the significant impact of MDR infections on patient outcome, even after adjustment on antimicrobial treatment adequacy, source control and all other ICU-and patientrelated determinants of 28-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study

et al. 2012

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“…24 We focus on severe sepsis as a single syndrome, rather than the underlying inciting infections, in line with current thinking that emphasizes the importance of the common host response in the pathogenesis and treatment of severe sepsis. 27–32 For patients who had more than 1 distinct septic hospitalization, each hospitalization was included, with appropriate adjustment of the standard errors as described below.…”

Section: Methodsmentioning

confidence: 99%

Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

Davydow¹,

Hough²,

Langa³

et al. 2013

The American Journal of Geriatric Psychiatry

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Objectives To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms. Design Prospective longitudinal cohort study. Setting Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998–2006). Participants 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview. Measurements Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims. Results The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis [Relative Risk (RR) 1.00, 95%Confidence Interval (95%CI) (0.73, 1.34)] nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, pre-sepsis substantial depressive symptoms [RR 2.20, 95%CI (1.66, 2.90)] and worse post-sepsis functional impairment [RR 1.08 per new limitation, 95%CI (1.03, 1.13)] were independently associated with substantial depressive symptoms following sepsis. Conclusions The prevalence of substantial depressive symptoms in severe sepsis survivors is high, but is not increased relative to their pre-sepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions prior to hospital discharge, may improve outcomes.

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“…This is likely attributable to the definition of combination therapy, which was based on the in vitro activity of noncarbapenems in the current study. This definition of combination therapy was chosen because the appropriateness of therapy for Gram-negative infections has been shown consistently to be associated with decreased mortality rates, particularly for critically ill patients (27)(28)(29). Additionally, unlike in previous studies, all included patients had carbapenem MICs of Ͼ2 g/ml; therefore, the use of a carbapenem was not considered a component of combination therapy.…”

Section: Discussionmentioning

confidence: 99%

Impact of Combination Antimicrobial Therapy on Mortality Risk for Critically Ill Patients with Carbapenem-Resistant Bacteremia

Bass

Bauer

Neuner

et al. 2015

Antimicrob Agents Chemother

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There are limited treatment options for carbapenem-resistant Gram-negative infections. Currently, there are suggestions in the literature that combination therapy should be used, which frequently includes antibiotics to which the causative pathogen demonstrates in vitro resistance. This case-control study evaluated risk factors associated with all-cause mortality rates for critically ill patients with carbapenem-resistant Gram-negative bacteremia. Adult patients who were admitted to an intensive care unit with sepsis and a blood culture positive for Gram-negative bacteria resistant to a carbapenem were included. Patients with polymicrobial, recurrent, or breakthrough infections were excluded. Included patients were classified as survivors (controls) or nonsurvivors (cases) at 30 days after the positive blood culture. Of 302 patients screened, 168 patients were included, of whom 90 patients died (53.6% [cases]) and 78 survived (46.4% [controls]) at 30 days. More survivors received appropriate antibiotics (antibiotics with in vitro activity) than did nonsurvivors (93.6% versus 53.3%; P < 0.01). Combination therapy, defined as multiple appropriate agents given for 48 h or more, was more common among survivors than nonsurvivors (32.1% versus 7.8%; P < 0.01); however, there was no difference in multiple-agent use when in vitro activity was not considered (including combinations with carbapenems) (87.2% versus 80%; P ‫؍‬ 0.21). After adjustment for baseline factors with multivariable logistic regression, combination therapy was independently associated with decreased risk of death (odds ratio, 0.19 [95% confidence interval, 0.06 to 0.56]; P < 0.01). These data suggest that combination therapy with multiple agents with in vitro activity is associated with improved survival rates for critically ill patients with carbapenem-resistant Gram-negative bacteremia. However, that association is lost if in vitro activity is not considered. Carbapenem resistance among Gram-negative bacteria has been increasingly reported (1). Between 2004 and 2008, the proportion of Klebsiella pneumoniae isolates resistant to meropenem in the United States increased from 0.6% to 5.6% (2). In certain geographic areas, such as New York City, prevalence rates are substantially higher and carbapenem resistance is considered endemic (3). Additionally, carbapenem resistance is a significant problem for critically ill patients admitted to an intensive care unit (ICU), as an ICU stay has consistently been shown to be an independent predictor of the acquisition of a carbapenem-resistant Gram-negative infection (4, 5).Furthermore, outcomes of carbapenem-resistant Gram-negative bacteremia are known to be poor. Infections with carbapenem-resistant Gram-negative organisms are associated with increased mortality rates, compared to carbapenem-susceptible organisms, and mortality rates are exceedingly high for these infections (4-8). In fact, attributable mortality rates for carbapenem-resistant Klebsiella pneumoniae bacteremia are as high as 50% (9). Additional...

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Outcomes in severe sepsis and patients with septic shock: Pathogen species and infection sites are not associated with mortality*

Abstract: 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.

Cited by 227 publications

References 39 publications

Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study

Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study

Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

Impact of Combination Antimicrobial Therapy on Mortality Risk for Critically Ill Patients with Carbapenem-Resistant Bacteremia

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