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Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis.
Hepatology. 2012 Dec; 56(6):2305-15.Hep

Abstract

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.

Authors+Show Affiliations

Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia. yaseenarabi@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22753144

Citation

Arabi, Yaseen M., et al. "Antimicrobial Therapeutic Determinants of Outcomes From Septic Shock Among Patients With Cirrhosis." Hepatology (Baltimore, Md.), vol. 56, no. 6, 2012, pp. 2305-15.
Arabi YM, Dara SI, Memish Z, et al. Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis. Hepatology. 2012;56(6):2305-15.
Arabi, Y. M., Dara, S. I., Memish, Z., Al Abdulkareem, A., Tamim, H. M., Al-Shirawi, N., Parrillo, J. E., Dodek, P., Lapinsky, S., Feinstein, D., Wood, G., Dial, S., Zanotti, S., & Kumar, A. (2012). Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis. Hepatology (Baltimore, Md.), 56(6), 2305-15. https://doi.org/10.1002/hep.25931
Arabi YM, et al. Antimicrobial Therapeutic Determinants of Outcomes From Septic Shock Among Patients With Cirrhosis. Hepatology. 2012;56(6):2305-15. PubMed PMID: 22753144.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis. AU - Arabi,Yaseen M, AU - Dara,Saqib I, AU - Memish,Ziad, AU - Al Abdulkareem,Abdulmajeed, AU - Tamim,Hani M, AU - Al-Shirawi,Nehad, AU - Parrillo,Joseph E, AU - Dodek,Peter, AU - Lapinsky,Stephen, AU - Feinstein,Daniel, AU - Wood,Gordon, AU - Dial,Sandra, AU - Zanotti,Sergio, AU - Kumar,Anand, AU - ,, PY - 2011/10/25/received PY - 2012/06/12/accepted PY - 2012/7/4/entrez PY - 2012/7/4/pubmed PY - 2013/3/1/medline SP - 2305 EP - 15 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 56 IS - 6 N2 - UNLABELLED: 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. SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/22753144/Antimicrobial_therapeutic_determinants_of_outcomes_from_septic_shock_among_patients_with_cirrhosis_ L2 - https://doi.org/10.1002/hep.25931 DB - PRIME DP - Unbound Medicine ER -