Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis
Hepatology, Volume 56, No. 6, Year 2012
Notification
URL copied to clipboard!
Description
It is unclear whether practice-related aspects of antimicrobial therapy contribute to the high mortality from septic shock among patients with cirrhosis. We examined the relationship between aspects of initial empiric antimicrobial therapy and mortality in patients with cirrhosis and septic shock. This was a nested cohort study within a large retrospective database of septic shock from 28 medical centers in Canada, the United States, and Saudi Arabia by the Cooperative Antimicrobial Therapy of Septic Shock Database Research Group between 1996 and 2008. We examined the impact of initial empiric antimicrobial therapeutic variables on the hospital mortality of patients with cirrhosis and septic shock. Among 635 patients with cirrhosis and septic shock, the hospital mortality was 75.6%. Inappropriate initial empiric antimicrobial therapy was administered in 155 (24.4%) patients. The median time to appropriate antimicrobial administration was 7.3 hours (interquartile range, 3.2-18.3 hours). The use of inappropriate initial antimicrobials was associated with increased mortality (adjusted odds ratio [aOR], 9.5; 95% confidence interval [CI], 4.3-20.7], as was the delay in appropriate antimicrobials (aOR for each 1 hour increase, 1.1; 95% CI, 1.1-1.2). Among patients with eligible bacterial septic shock, a single rather than two or more appropriate antimicrobials was used in 226 (72.9%) patients and was also associated with higher mortality (aOR, 1.8; 95% CI, 1.0-3.3). These findings were consistent across various clinically relevant subgroups. Conclusion: In patients with cirrhosis and septic shock, inappropriate and delayed appropriate initial empiric antimicrobial therapy is associated with increased mortality. Monotherapy of bacterial septic shock is also associated with increased mortality. The process of selection and implementation of empiric antimicrobial therapy in this high-risk group should be restructured. © 2012 American Association for the Study of Liver Diseases.
Authors & Co-Authors
Arabi, Yaseen M.
Saudi Arabia, Riyadh
King Abdulaziz Medical City - Riyadh
Dara, Saqib I.
Saudi Arabia, Riyadh
King Abdulaziz Medical City - Riyadh
Al Memish, Ziad Ahmed
Saudi Arabia, Riyadh
College of Medicine-riyadh
Saudi Arabia, Riyadh
King Abdulaziz Medical City - Riyadh
Al Abdulkareem, Abdulmajeed
Saudi Arabia, Riyadh
Ministry of Health Saudi Arabia
Tamim, Hani Mohammed
Saudi Arabia, Riyadh
College of Medicine Alfaisal University
Al Shirawi, Nehad
Saudi Arabia, Riyadh
King Abdulaziz Medical City - Riyadh
Parrillo, Joseph E.
United States, Camden
Cooper Medical School of Rowan University
Dodek, Peter M.
Canada, Vancouver
The University of British Columbia
Lapinsky, Stephen Earl
Canada, Toronto
University of Toronto
Feinstein, Daniel
United States, Greensboro
The Moses H. Cone Memorial Hospital
Wood, Gordon G.
Canada, Vancouver
The University of British Columbia
Dial, Sandra
Canada, Montreal
Université Mcgill
Zanotti, Sergio
United States, Camden
Cooper Medical School of Rowan University
Kumar, Anand
Canada, Winnipeg
University of Manitoba
United States, Camden
Cooper Medical School of Rowan University
Statistics
Citations: 132
Authors: 14
Affiliations: 10
Identifiers
Doi:
10.1002/hep.25931
ISSN:
02709139
Research Areas
Health System And Policy
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative