Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy

David D. Leedahl, Heather A. Personett, Ognjen Gajic, Rahul Kashyap, Garrett E. Schramm

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Factors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care.Methods: We conducted a secondary subgroup analysis of a prospective severe sepsis cohort study. Patients with septic shock and positive blood cultures who received appropriate antimicrobial therapy were included. Univariable analyses were used to identify differences between hospital survivors and non-survivors, and a multivariable logistic regression model revealed independent determinants of hospital mortality.Results: From January 2008 to December 2010, 58 of 224 included patients died in the hospital. Multivariable logistic regression analysis demonstrated 2 independent predictors of hospital mortality. These included continuous renal replacement therapy utilization within 48 hours of septic shock recognition (adjusted odds ratio [OR], 5.52; 95% confidence interval [CI], 1.94-16.34) and intra-abdominal infection (adjusted OR, 3.92; 95% CI, 1.47-10.79). Escherichia coli was independently associated with a lower risk of hospital mortality (adjusted OR, 0.34; 95% CI, 0.11-0.90).Conclusion: Intra-abdominal infection and continuous renal replacement therapy were associated with increased hospital mortality in patients with septic shock who received appropriate antimicrobial therapy. Our findings may be explained by suboptimal intra-abdominal infection management or inadequate antimicrobial concentration in these patients.

Original languageEnglish (US)
Article number21
JournalBMC Anesthesiology
Volume14
DOIs
StatePublished - Mar 25 2014

Fingerprint

Septic Shock
Hospital Mortality
Intraabdominal Infections
Mortality
Renal Replacement Therapy
Logistic Models
Odds Ratio
Confidence Intervals
Therapeutics
Resuscitation
Survivors
Sepsis
Cohort Studies
Regression Analysis
Escherichia coli

Keywords

  • Antimicrobials
  • Bacteremia
  • Hospital mortality
  • Outcome
  • Septic shock

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy. / Leedahl, David D.; Personett, Heather A.; Gajic, Ognjen; Kashyap, Rahul; Schramm, Garrett E.

In: BMC Anesthesiology, Vol. 14, 21, 25.03.2014.

Research output: Contribution to journalArticle

Leedahl, David D. ; Personett, Heather A. ; Gajic, Ognjen ; Kashyap, Rahul ; Schramm, Garrett E. / Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy. In: BMC Anesthesiology. 2014 ; Vol. 14.
@article{c6ae8a91f5cf4c91a9a1552306e15cf6,
title = "Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy",
abstract = "Background: Factors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care.Methods: We conducted a secondary subgroup analysis of a prospective severe sepsis cohort study. Patients with septic shock and positive blood cultures who received appropriate antimicrobial therapy were included. Univariable analyses were used to identify differences between hospital survivors and non-survivors, and a multivariable logistic regression model revealed independent determinants of hospital mortality.Results: From January 2008 to December 2010, 58 of 224 included patients died in the hospital. Multivariable logistic regression analysis demonstrated 2 independent predictors of hospital mortality. These included continuous renal replacement therapy utilization within 48 hours of septic shock recognition (adjusted odds ratio [OR], 5.52; 95{\%} confidence interval [CI], 1.94-16.34) and intra-abdominal infection (adjusted OR, 3.92; 95{\%} CI, 1.47-10.79). Escherichia coli was independently associated with a lower risk of hospital mortality (adjusted OR, 0.34; 95{\%} CI, 0.11-0.90).Conclusion: Intra-abdominal infection and continuous renal replacement therapy were associated with increased hospital mortality in patients with septic shock who received appropriate antimicrobial therapy. Our findings may be explained by suboptimal intra-abdominal infection management or inadequate antimicrobial concentration in these patients.",
keywords = "Antimicrobials, Bacteremia, Hospital mortality, Outcome, Septic shock",
author = "Leedahl, {David D.} and Personett, {Heather A.} and Ognjen Gajic and Rahul Kashyap and Schramm, {Garrett E.}",
year = "2014",
month = "3",
day = "25",
doi = "10.1186/1471-2253-14-21",
language = "English (US)",
volume = "14",
journal = "BMC Anesthesiology",
issn = "1471-2253",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy

AU - Leedahl, David D.

AU - Personett, Heather A.

AU - Gajic, Ognjen

AU - Kashyap, Rahul

AU - Schramm, Garrett E.

PY - 2014/3/25

Y1 - 2014/3/25

N2 - Background: Factors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care.Methods: We conducted a secondary subgroup analysis of a prospective severe sepsis cohort study. Patients with septic shock and positive blood cultures who received appropriate antimicrobial therapy were included. Univariable analyses were used to identify differences between hospital survivors and non-survivors, and a multivariable logistic regression model revealed independent determinants of hospital mortality.Results: From January 2008 to December 2010, 58 of 224 included patients died in the hospital. Multivariable logistic regression analysis demonstrated 2 independent predictors of hospital mortality. These included continuous renal replacement therapy utilization within 48 hours of septic shock recognition (adjusted odds ratio [OR], 5.52; 95% confidence interval [CI], 1.94-16.34) and intra-abdominal infection (adjusted OR, 3.92; 95% CI, 1.47-10.79). Escherichia coli was independently associated with a lower risk of hospital mortality (adjusted OR, 0.34; 95% CI, 0.11-0.90).Conclusion: Intra-abdominal infection and continuous renal replacement therapy were associated with increased hospital mortality in patients with septic shock who received appropriate antimicrobial therapy. Our findings may be explained by suboptimal intra-abdominal infection management or inadequate antimicrobial concentration in these patients.

AB - Background: Factors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care.Methods: We conducted a secondary subgroup analysis of a prospective severe sepsis cohort study. Patients with septic shock and positive blood cultures who received appropriate antimicrobial therapy were included. Univariable analyses were used to identify differences between hospital survivors and non-survivors, and a multivariable logistic regression model revealed independent determinants of hospital mortality.Results: From January 2008 to December 2010, 58 of 224 included patients died in the hospital. Multivariable logistic regression analysis demonstrated 2 independent predictors of hospital mortality. These included continuous renal replacement therapy utilization within 48 hours of septic shock recognition (adjusted odds ratio [OR], 5.52; 95% confidence interval [CI], 1.94-16.34) and intra-abdominal infection (adjusted OR, 3.92; 95% CI, 1.47-10.79). Escherichia coli was independently associated with a lower risk of hospital mortality (adjusted OR, 0.34; 95% CI, 0.11-0.90).Conclusion: Intra-abdominal infection and continuous renal replacement therapy were associated with increased hospital mortality in patients with septic shock who received appropriate antimicrobial therapy. Our findings may be explained by suboptimal intra-abdominal infection management or inadequate antimicrobial concentration in these patients.

KW - Antimicrobials

KW - Bacteremia

KW - Hospital mortality

KW - Outcome

KW - Septic shock

UR - http://www.scopus.com/inward/record.url?scp=84899137376&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899137376&partnerID=8YFLogxK

U2 - 10.1186/1471-2253-14-21

DO - 10.1186/1471-2253-14-21

M3 - Article

C2 - 24661842

AN - SCOPUS:84899137376

VL - 14

JO - BMC Anesthesiology

JF - BMC Anesthesiology

SN - 1471-2253

M1 - 21

ER -