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Central-line-related septic shock: early appropriate antimicrobial therapy and rapid source control reduce mortality

Introduction

Catheter-related septic shock is an increasingly common entity in the ICU. Current recommendations for early line removal and rapid administration of appropriate antibiotics are largely based upon expert opinion. No study of line-related septic shock has been reported.

Methods

A retrospective review of 5,715 cases of septic shock from 24 adult ICUs revealed 217 cases thought to be catheter related. Time from onset of hypotension to both appropriate antibiotic therapy and line removal were assessed, and mortality differences observed.

Results

The most commonly recovered organisms were Staphylococcus aureus, Candida albicans, and Klebsiella sp. Overall, 31% of infections were Gram-negative, 31% were Gram-positive, and 34% were fungal. Survival to hospital discharge was 51.6%, and the average hospital stay was 26.09 days. The average APACHE II score was 26.12 (SD ± 7.6). Survival among patients who received initiation of antibiotics within 0–3 hours of hypotension was 82.4%, but declined to 62.9% from 3 to 6 hours and then to 55.9% from 6 to 12 hours. Survival among patients given antibiotics from 12 to 24 hours and then >24 hours was 48% and 13%, respectively. Discontinuation of the infected central venous catheter before 6 hours after the onset of hypotension resulted in a survival of 90%. However, survival was 79% if catheter removal occurred from 6 to 12 hours, 63% from 12 to 24 hours, and 21% if removal happened at any time after 24 hours. Multivariate analysis demonstrated that delays from onset of hypotension to both appropriate antimicrobials and line removal exerted independent adverse effects on survival.

Conclusion

This study clearly demonstrates the mortality benefit of both early appropriate antibiotics and rapid line removal in catheter-related septic shock.

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Low, R., Ahsan, M., Chou, H. et al. Central-line-related septic shock: early appropriate antimicrobial therapy and rapid source control reduce mortality. Crit Care 12, P397 (2008). https://doi.org/10.1186/cc6618

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Keywords

  • Septic Shock
  • Candida Albicans
  • Central Venous Catheter
  • Catheter Removal
  • Mortality Benefit