Does early appropriate antibiotic therapy improve the outcome of severe sepsis or septic shock?

Introduction

The Surviving Sepsis Campaign Guideline 2008 [1] recommends starting appropriate antibiotic therapy within 1 hour after making the diagnosis of septic shock. In the ICU of our emergency center, we perform empiric antibiotic therapy for septic shock patients within 6 hours after admission.

Methods

Cases of severe sepsis or septic shock diagnosed and treated in the ICU of our emergency center for more than 48 hours between January 2005 and September 2008 were retrospectively analyzed. The cases were divided into a survival group and a nonsurvival group, and were compared in relation to primary diagnosis, clinical findings, and type of pathogen. The chi-square test and paired t test were used to perform the statistical analysis.

Results

There were 107 cases, 24 cases of severe sepsis and 83 cases of septic shock, and 73 of them were in males. The mean and standard deviation of the patients' age was 66.4 ± 15 years. The severity of their illness according to the APACHE II score was 22.3 ± 8, and their Sequential Organ Failure Assessment score was 9.1 ± 4. The causes of the sepsis were pneumonia (51.4%), peritonitis (13.1%), and soft tissue infection (13.1%). Mortality was 26.2%. There were 79 cases in the survival group and 28 in the nonsurvival group. The two groups are presented in Table 1. We performed a multivariate regression analysis to identify prognostic factors, and the only independent prognostic factors were age (OR = 0.955 (P = 0.022; 95% CI = 0.91 to 0.99)), acute respiratory disease syndrome (ARDS) (OR = 5.789 (P = 0.002; 95% CI = 1.91 to 17.4)) and base deficit (OR = 1.113 (P = 0.008; 95% CI = 1.02 to 1.2)). Early appropriate antibiotic therapy (EAAT) was not correlated with survival.

Table 1 (abstract P320)

Conclusion

EAAT did not affect the outcome. The prognostic factors for severe sepsis and septic shock identified in this study were age, base deficit and ARDS.