Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study

Bloos, Frank; Thomas-Rüddel, Daniel; Rüddel, Hendrik; Engel, Christoph; Schwarzkopf, Daniel; Marshall, John C; Harbarth, Stephan; Simon, Philipp; Riessen, Reimer; Keh, Didier; Dey, Karin; Weiß, Manfred; Toussaint, Susanne; Schädler, Dirk; Weyland, Andreas; Ragaller, Maximillian; Schwarzkopf, Konrad; Eiche, Jürgen; Kuhnle, Gerhard; Hoyer, Heike; Hartog, Christiane; Kaisers, Udo; Reinhart, Konrad

doi:10.1186/cc13755

Critical Care

Table 5 Multivariate logistic regression model for the impact of patient-related factors on 28-day mortality

From: Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study

Variable	Odds ratios (95% CI)	P value
All patients ( n = 725)^a
Time to antimicrobial therapy >1 hour^b	0.81 (0.54 to 1.23)	0.323
Initial SOFA score^c	1.19 (1.13 to 1.26)	<0.001
Age^d	1.04 (1.03 o 1.06)	<0.001
Maximum lactate (day 1)^e	1.09 (1.04 to 1.14)	<0.001
Intra-abdominal focus	1.08 (0.75 to 1.57)	0.670
Urogenital focus	0.65 (0.36 to 1.14)	0.143
Unknown focus	1.26 (0.57 to 2.78)	0.574
Community-acquired infection	0.89 (0.65 to 1.22)	0.484
Inadequate empiric antimicrobial therapy	1.44 (1.05 to 1.99)	0.026
No de-escalation of antimicrobials within 5 days	1.17 (0.66 to 2.14)	0.597
Surgical source control required ( n = 234)^f
Time to antimicrobial therapy >1 hour^b	0.80 (0.38 to 1.72)	0.552
Initial SOFA score^c	1.19 (1.08 to 1.31)	<0.001
Age^d	1.06 (1.03 to 1.08)	<0.001
Maximum lactate (day 1)^e	1.08 (1.00 to 1.13)	0.046
Time to source control >6 hours	2.36 (1.22 to 4.71)	0.012
Intra-abdominal focus	1.08 (0.54 to 2.18)	0.822
Urogenital focus	0.43 (0.12 to 1.34)	0.165
Unknown focus^g	–	–
Community-acquired infection	1.08 (0.58 to 2.04)	0.800
Inadequate empiric antimicrobial therapy	1.17 (0.61 to 2.24)	0.646
No de-escalation of antimicrobials within 5 days	0.94 (0.33 to 2.81)	0.909
No surgical source control required ( n = 424)^h
Time to antimicrobial therapy >1 hour^b	0.69 (0.39 to 1.21)	0.189
Initial SOFA score^c	1.19 (1.11 to 1.28)	<0.001
Age^d	1.04 (1.02 to 1.06)	<0.001
Maximum lactate (day 1)^e	1.12 (1.05 to 1.20)	0.001
Intra-abdominal focus	1.72 (0.93 to 3.19)	0.083
Urogenital focus	0.95 (0.47 to 1.86)	0.875
Unknown focus	1.67 (0.70 to 3.98)	0.243
Community-acquired infection	1.03 (0.64 to 1.65)	0.904
Inadequate empiric antimicrobial therapy	1.52 (0.95 to 2.42)	0.078
No de-escalation of antimicrobials within 5 days	2.71 (1.02 to 8.40)	0.061

Adjusted odds ratios and 95% confidence intervals (CIs) for 28-day mortality. Only patients with initiation of antimicrobial therapy as well as source control after development of organ dysfunction and with complete observations in all variables are entered into this analysis. Parameters not included due to result in the monovariate analysis: surgical or interventional source control required (P = 0.223), status of blood culture withdrawal (P = 0.779), pulmonary focus (P = 0.491), other focus than intra-abdominal, pulmonary, urogenital or unknown (P = 0.691). Inadequate antimicrobial therapy was defined as escalation of empiric antimicrobial therapy within 5 days. All models showed a good separation of the outcome (c-statistic >0.7) and a good calibration (P > 0.05 in the Hosmer–Lemeshow test (pHLT)). SOFA, Sequential Organ Failure Assessment. ^aGoodness of fit: c = 0.76, pHLT = 0.904. ^bAgainst previous antimicrobial therapy and antimicrobials within 1 hour after infection-related onset of organ dysfunction. ^cPer point increase. ^dPer year. ^ePer mmol/l. ^fGoodness of fit: c = 0.79, pHLT = 0.733. ^gInsufficient sample size in this subgroup. ^hGoodness of fit: c = 0.77, pHLT = 0.887.

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