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Impact of Sepsis Classification and Multidrug-Resistance Status on Outcome Among Patients Treated With Appropriate Therapy.
Crit Care Med. 2015 Aug; 43(8):1580-6.CC

Abstract

OBJECTIVE

To assess the impact of sepsis classification and multidrug-resistance status on outcome in patients receiving appropriate initial antibiotic therapy.

DESIGN

A retrospective cohort study.

SETTING

Barnes-Jewish Hospital, a 1,250-bed teaching hospital.

PATIENTS

Individuals with Enterobacteriaceae sepsis, severe sepsis, and septic shock who received appropriate initial antimicrobial therapy between June 2009 and December 2013.

INTERVENTIONS

Clinical outcomes were compared according to multidrug-resistance status, sepsis classification, demographics, severity of illness, comorbidities, and antimicrobial treatment.

MEASUREMENTS AND MAIN RESULTS

We identified 510 patients with Enterobacteriaceae bacteremia and sepsis, severe sepsis, or septic shock. Sixty-seven patients (13.1%) were nonsurvivors. Mortality increased significantly with increasing severity of sepsis (3.5%, 9.9%, and 28.6%, for sepsis, severe sepsis, and septic shock, respectively; p < 0.05). Time to antimicrobial therapy was not significantly associated with outcome. Acute Physiology and Chronic Health Evaluation II was more predictive of mortality than age-adjusted Charlson comorbidity index. Multidrug-resistance status did not result in excess mortality. Length of ICU and hospital stay increased with more severe sepsis. In multivariate logistic regression analysis, African-American race, sepsis severity, Acute Physiology and Chronic Health Evaluation II score, solid-organ cancer, cirrhosis, and transfer from an outside hospital were all predictors of mortality.

CONCLUSIONS

Our results support sepsis severity, but not multidrug-resistance status as being an important predictor of death when all patients receive appropriate initial antibiotic therapy. Future sepsis trials should attempt to provide appropriate antimicrobial therapy and take sepsis severity into careful account when determining outcomes.

Authors+Show Affiliations

1Division of Medical Education, Washington University School of Medicine, St. Louis, MO. 2Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO. 3Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25855900

Citation

Burnham, Jason P., et al. "Impact of Sepsis Classification and Multidrug-Resistance Status On Outcome Among Patients Treated With Appropriate Therapy." Critical Care Medicine, vol. 43, no. 8, 2015, pp. 1580-6.
Burnham JP, Lane MA, Kollef MH. Impact of Sepsis Classification and Multidrug-Resistance Status on Outcome Among Patients Treated With Appropriate Therapy. Crit Care Med. 2015;43(8):1580-6.
Burnham, J. P., Lane, M. A., & Kollef, M. H. (2015). Impact of Sepsis Classification and Multidrug-Resistance Status on Outcome Among Patients Treated With Appropriate Therapy. Critical Care Medicine, 43(8), 1580-6. https://doi.org/10.1097/CCM.0000000000001013
Burnham JP, Lane MA, Kollef MH. Impact of Sepsis Classification and Multidrug-Resistance Status On Outcome Among Patients Treated With Appropriate Therapy. Crit Care Med. 2015;43(8):1580-6. PubMed PMID: 25855900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Sepsis Classification and Multidrug-Resistance Status on Outcome Among Patients Treated With Appropriate Therapy. AU - Burnham,Jason P, AU - Lane,Michael A, AU - Kollef,Marin H, PY - 2015/4/10/entrez PY - 2015/4/10/pubmed PY - 2015/10/2/medline SP - 1580 EP - 6 JF - Critical care medicine JO - Crit Care Med VL - 43 IS - 8 N2 - OBJECTIVE: To assess the impact of sepsis classification and multidrug-resistance status on outcome in patients receiving appropriate initial antibiotic therapy. DESIGN: A retrospective cohort study. SETTING: Barnes-Jewish Hospital, a 1,250-bed teaching hospital. PATIENTS: Individuals with Enterobacteriaceae sepsis, severe sepsis, and septic shock who received appropriate initial antimicrobial therapy between June 2009 and December 2013. INTERVENTIONS: Clinical outcomes were compared according to multidrug-resistance status, sepsis classification, demographics, severity of illness, comorbidities, and antimicrobial treatment. MEASUREMENTS AND MAIN RESULTS: We identified 510 patients with Enterobacteriaceae bacteremia and sepsis, severe sepsis, or septic shock. Sixty-seven patients (13.1%) were nonsurvivors. Mortality increased significantly with increasing severity of sepsis (3.5%, 9.9%, and 28.6%, for sepsis, severe sepsis, and septic shock, respectively; p < 0.05). Time to antimicrobial therapy was not significantly associated with outcome. Acute Physiology and Chronic Health Evaluation II was more predictive of mortality than age-adjusted Charlson comorbidity index. Multidrug-resistance status did not result in excess mortality. Length of ICU and hospital stay increased with more severe sepsis. In multivariate logistic regression analysis, African-American race, sepsis severity, Acute Physiology and Chronic Health Evaluation II score, solid-organ cancer, cirrhosis, and transfer from an outside hospital were all predictors of mortality. CONCLUSIONS: Our results support sepsis severity, but not multidrug-resistance status as being an important predictor of death when all patients receive appropriate initial antibiotic therapy. Future sepsis trials should attempt to provide appropriate antimicrobial therapy and take sepsis severity into careful account when determining outcomes. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/25855900/Impact_of_Sepsis_Classification_and_Multidrug_Resistance_Status_on_Outcome_Among_Patients_Treated_With_Appropriate_Therapy_ L2 - https://dx.doi.org/10.1097/CCM.0000000000001013 DB - PRIME DP - Unbound Medicine ER -