Tags

Type your tag names separated by a space and hit enter

Association between source of infection and hospital mortality in patients who have septic shock.
Am J Respir Crit Care Med. 2014 May 15; 189(10):1204-13.AJ

Abstract

RATIONALE

Mortality caused by septic shock may be determined by a systemic inflammatory response, independent of the inciting infection, but it may also be influenced by the anatomic source of infection.

OBJECTIVES

To determine the association between the anatomic source of infection and hospital mortality in critically ill patients who have septic shock.

METHODS

This was a retrospective, multicenter cohort study of 7,974 patients who had septic shock in 29 academic and community intensive care units in Canada, the United States, and Saudi Arabia from January 1989 to May 2008.

MEASUREMENTS AND MAIN RESULTS

Subjects were assigned 1 of 20 anatomic sources of infection based on clinical diagnosis and/or isolation of pathogens. The primary outcome was hospital mortality. Overall crude hospital mortality was 52% (21-85% across sources of infection). Variation in mortality remained after adjusting for year of admission, geographic source of admission, age, sex, comorbidities, community- versus hospital-acquired infection, and organism type. The source of infection with the highest standardized hospital mortality was ischemic bowel (75%); the lowest was obstructive uropathy-associated urinary tract infection (26%). Residual variation in adjusted hospital mortality was not explained by Acute Physiology and Chronic Health Evaluation II score, number of Day 1 organ failures, bacteremia, appropriateness of empiric antimicrobials, or adjunct therapies. In patients who received appropriate antimicrobials after onset of hypotension, source of infection was associated with death after adjustment for both predisposing and downstream factors.

CONCLUSIONS

Anatomic source of infection should be considered in future trial designs and analyses, and in development of prognostic scoring systems.

Authors+Show Affiliations

1 Department of Internal Medicine and.No 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
Observational Study

Language

eng

PubMed ID

24635548

Citation

Leligdowicz, Aleksandra, et al. "Association Between Source of Infection and Hospital Mortality in Patients Who Have Septic Shock." American Journal of Respiratory and Critical Care Medicine, vol. 189, no. 10, 2014, pp. 1204-13.
Leligdowicz A, Dodek PM, Norena M, et al. Association between source of infection and hospital mortality in patients who have septic shock. Am J Respir Crit Care Med. 2014;189(10):1204-13.
Leligdowicz, A., Dodek, P. M., Norena, M., Wong, H., Kumar, A., & Kumar, A. (2014). Association between source of infection and hospital mortality in patients who have septic shock. American Journal of Respiratory and Critical Care Medicine, 189(10), 1204-13. https://doi.org/10.1164/rccm.201310-1875OC
Leligdowicz A, et al. Association Between Source of Infection and Hospital Mortality in Patients Who Have Septic Shock. Am J Respir Crit Care Med. 2014 May 15;189(10):1204-13. PubMed PMID: 24635548.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between source of infection and hospital mortality in patients who have septic shock. AU - Leligdowicz,Aleksandra, AU - Dodek,Peter M, AU - Norena,Monica, AU - Wong,Hubert, AU - Kumar,Aseem, AU - Kumar,Anand, AU - ,, PY - 2014/3/19/entrez PY - 2014/3/19/pubmed PY - 2014/8/13/medline SP - 1204 EP - 13 JF - American journal of respiratory and critical care medicine JO - Am J Respir Crit Care Med VL - 189 IS - 10 N2 - RATIONALE: Mortality caused by septic shock may be determined by a systemic inflammatory response, independent of the inciting infection, but it may also be influenced by the anatomic source of infection. OBJECTIVES: To determine the association between the anatomic source of infection and hospital mortality in critically ill patients who have septic shock. METHODS: This was a retrospective, multicenter cohort study of 7,974 patients who had septic shock in 29 academic and community intensive care units in Canada, the United States, and Saudi Arabia from January 1989 to May 2008. MEASUREMENTS AND MAIN RESULTS: Subjects were assigned 1 of 20 anatomic sources of infection based on clinical diagnosis and/or isolation of pathogens. The primary outcome was hospital mortality. Overall crude hospital mortality was 52% (21-85% across sources of infection). Variation in mortality remained after adjusting for year of admission, geographic source of admission, age, sex, comorbidities, community- versus hospital-acquired infection, and organism type. The source of infection with the highest standardized hospital mortality was ischemic bowel (75%); the lowest was obstructive uropathy-associated urinary tract infection (26%). Residual variation in adjusted hospital mortality was not explained by Acute Physiology and Chronic Health Evaluation II score, number of Day 1 organ failures, bacteremia, appropriateness of empiric antimicrobials, or adjunct therapies. In patients who received appropriate antimicrobials after onset of hypotension, source of infection was associated with death after adjustment for both predisposing and downstream factors. CONCLUSIONS: Anatomic source of infection should be considered in future trial designs and analyses, and in development of prognostic scoring systems. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/24635548/Association_between_source_of_infection_and_hospital_mortality_in_patients_who_have_septic_shock_ L2 - https://www.atsjournals.org/doi/10.1164/rccm.201310-1875OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -