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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock
Chest, Volume 136, No. 5, Year 2009
Notification
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Description
Objective: Our goal was to determine the impact of the initiation of inappropriate antimicrobial therapy on survival to hospital discharge of patients with septic shock. Methods: The appropriateness of initial antimicrobial therapy, the clinical infection site, and relevant pathogens were retrospectively determined for 5,715 patients with septic shock in three countries. Results: Therapy with appropriate antimicrobial agents was initiated in 80.1% of cases. Overall, the survival rate was 43.7%. There were marked differences in the distribution of comorbidities, clinical infections, and pathogens in patients who received appropriate and inappropriate initial antimicrobial therapy (p < 0.0001 for each). The survival rates after appropriate and inappropriate initial therapy were 52.0% and 10.3%, respectively (odds ratio [OR], 9.45; 95% CI, 7.74 to 11.54; p < 0.0001). Similar differences in survival were seen in all major epidemiologic, clinical, and organism subgroups. The decrease in survival with inappropriate initial therapy ranged from 2.3-fold for pneumococcal infection to 17.6-fold with primary bacteremia. After adjustment for acute physiology and chronic health evaluation II score, comorbidities, hospital site, and other potential risk factors, the inappropriateness of initial antimicrobial therapy remained most highly associated with risk of death (OR, 8.99; 95% CI, 6.60 to 12.23). Conclusions: Inappropriate initial antimicrobial therapy for septic shock occurs in about 20% of patients and is associated with a fivefold reduction in survival. Efforts to increase the frequency of the appropriateness of initial antimicrobial therapy must be central to efforts to reduce the mortality of patients with septic shock. © 2009 American College of Chest Physicians.
Authors & Co-Authors
Kumar, Anand
Canada, Winnipeg
University of Manitoba
United States, Camden
Cooper University Hospital
Ellis, Paul
Canada, Toronto
University Health Network University of Toronto
Arabi, Yaseen M.
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Roberts, Dan
Canada, Winnipeg
University of Manitoba
Light, R. Bruce
Canada, Winnipeg
University of Manitoba
Canada, Winnipeg
Office Régional de la Santé de Winnipeg
Parrillo, Joseph E.
United States, Camden
Cooper University Hospital
Dodek, Peter M.
Canada, Vancouver
The University of British Columbia
Wood, Gordon G.
Canada, Victoria
Vancouver Island Health Authority
Kumar, Aseem C.Ramesh
Canada, Sudbury
Université Laurentienne
Simon, David M.
United States, Chicago
Rush University Medical Center
Peters, Cheryl
Canada, Winnipeg
University of Manitoba
Ahsan, Muhammad
Canada, Winnipeg
University of Manitoba
Chateau, Dan
Canada, Winnipeg
University of Manitoba
Wood, Kenneth E.
United States, Madison
Uw Health
Laupland, K. B.
Canada, Calgary
Foothills Medical Centre
Kramer, Andreas H.
Canada, Brandon
Brandon General Hospital
Sharma, S.
Canada, Winnipeg
Office Régional de la Santé de Winnipeg
Lapinsky, Stephen Earl
Canada, Toronto
Mount Sinai Hospital of University of Toronto
Marshall, John C.
Canada, Toronto
Saint Michael's Hospital University of Toronto
Dial, Sandra
Canada, Montreal
Sir Mortimer B. Davis Jewish General Hospital
Skrobik, Ionna
Canada, Montreal
Hôpital Maisonneuve-rosemont
Patel, Gourang
United States, Chicago
Rush University Medical Center
Gurka, Dave
United States, Chicago
Rush University Medical Center
Zanotti, Sergio
United States, Camden
Cooper University Hospital
Dellinger, Richard Phillip
United States, Camden
Cooper University Hospital
Feinstein, Daniel
United States, Baltimore
St. Agnes Hospital
Guzman, Jorge
United States, Detroit
Harper University Hospital
Al Shirawi, Nehad
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Al Memish, Ziad Ahmed
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Ronald, John
Canada
Nanaimo Regional Hospital
Suleman, Mustafa
Canada, Winnipeg
Concordia Hospital
Gulati, Harleena
Canada, Winnipeg
University of Manitoba
Halmarson, Erica
Canada, Winnipeg
University of Manitoba
Suppes, Robert
Canada, Winnipeg
University of Manitoba
Sullivan, Katherine
Canada, Winnipeg
University of Manitoba
Bohmeier, Rob
Canada, Winnipeg
University of Manitoba
Muggaberg, Sheri
Canada, Winnipeg
University of Manitoba
Kravetsky, Laura B.
Canada, Winnipeg
University of Manitoba
Singh, Amrinder
Unknown Affiliation
Carter, Lindsey
Unknown Affiliation
Wiebe, Kym
Canada, Winnipeg
Hôpital St-boniface
Kolesar, Laura
Canada, Winnipeg
Hôpital St-boniface
Richards, Jody
Canada, Victoria
Camosun College
Jaswal, Danny
Canada, Vancouver
The University of British Columbia
Chou, Harris
Canada, Vancouver
The University of British Columbia
Kosick, Tom
Canada, Vancouver
The University of British Columbia
Fu, Winnie
Canada, Vancouver
The University of British Columbia
Chan, Charlena
Canada, Vancouver
The University of British Columbia
Ren, Jia Jia
Canada, Vancouver
The University of British Columbia
Bahrainian, Mozdeh
Unknown Affiliation
Haque, Ziaul
Unknown Affiliation
Torshizi, Omid Ahmadi
Unknown Affiliation
Paulin, Heidi
Canada, Toronto
University of Toronto
Khan, Farah
Unknown Affiliation
Kumar, Runjun
Canada, Toronto
University of Toronto
Harvey, Johanne
Canada, Montreal
Hôpital Maisonneuve-rosemont
Kim, Christina
Canada, Montreal
Université Mcgill
Li, Jennifer
Canada, Montreal
Université Mcgill
Campbell, Latoya
Canada, Montreal
Université Mcgill
Taiberg, Leo
United States, Chicago
Rush Medical College
Schorr, Christa
United States, Camden
Cooper University Hospital
Tchokonte, Ronny
United States, Detroit
Wayne State University School of Medicine
Gonzales, Catherine
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Serrano, Norrie
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Delgra, Sofia
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Statistics
Citations: 571
Authors: 65
Affiliations: 26
Identifiers
Doi:
10.1378/chest.09-0087
ISSN:
00123692
e-ISSN:
19313543
Research Areas
Health System And Policy
Study Design
Case-Control Study