Prehospital administered intravenous antimicrobial protocol for septic shock: a prospective randomized clinical trial
- D Chamberlain1
© Chamberlain; licensee BioMed Central Ltd. 2009
Published: 13 March 2009
Appropriate intravenous, broad-spectrum empiric antimicrobial therapy should be initiated as rapidly as possible for suspected severe infections in the presence of hypotension. Timing and delay of initial administration of effective antimicrobial therapy is an important predictor of survival . It is hypothesized that appropriate prehospital-initiated intravenous, broad-spectrum empiric antimicrobial therapy will reduce the delay of administration and will reduce mortality .
One hundred and ninety-eight patients meeting the criteria for septic shock on initial clinical presentation prehospital were randomized to receiving broad-spectrum intravenous antimicrobial therapy and fluid per guided protocol or to receiving intravenous fluid only.
Out of 198 septic shock patients, 99 received prehospital antimicrobial therapy. Blood cultures were taken prior to administration. Both groups were comparable in all aspects. There were 83 male and 26 female patients in the test group, and 79 male and 20 female patients in the control group (P = 0.021). Mean age was 67.9 ± 10.5 years in the test group and 63.8 ± 11.0 years in the control group (P = 0.186). The APACHE II score in the test group and in the control group was statistically not significant (P = 0.661). In the test group 28%, compared with the control group 53%, of patients had community-acquired pneumonia (P = 0.083). The mean intensive care stay in the test group was 6.8 ± 2.1 days and in the control group it was 11.2 ± 5.2 days (P = 0.001). The first antimicrobial administration after emergency department admission time in the control group was 3.4 ± 2.6 hours (P = 0.02). The 28-day mortality rate was significantly reduced to 42.4% (test group) compared with 56.7% in the control group (P = 0.049, OR = 0.56; 95% CI = 0.32 to 1.00).
The adjuvant treatment of patients with a guided prehospital-initiated broad-spectrum antimicrobial therapy with intravenous fluid reduces the delay in antimicrobial administration and significantly reduces the 28-day mortality rate in patients with septic shock.
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