Resistance to Empiric Antimicrobial Treatment Predicts Outcome in Severe Sepsis Associated with Gram-Negative Bacteremia

被引:55
作者
Micek, Scott T. [1 ]
Welch, Emily C. [1 ]
Khan, Junaid [2 ]
Pervez, Mubashir [2 ]
Doherty, Joshua A. [3 ]
Reichley, Richard M. [3 ]
Hoppe-Bauer, Joan [4 ]
Dunne, W. Michael [4 ]
Kollef, Marin H. [2 ]
机构
[1] Barnes Jewish Hosp, Dept Pharm, St Louis, MO 63110 USA
[2] Washington Univ, Sch Med, Div Pulm & Crit Care, St Louis, MO 63110 USA
[3] BJC Healthcare, Hosp Informat Grp, St Louis, MO USA
[4] Barnes Jewish Hosp, Dept Lab Med, St Louis, MO 63110 USA
关键词
PSEUDOMONAS-AERUGINOSA; ANTIBIOTIC-THERAPY; SEPTIC SHOCK; COMBINATION; INFECTIONS; TRIAL; SUSCEPTIBILITY; MONOTHERAPY; GUIDELINES; MANAGEMENT;
D O I
10.1002/jhm.899
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Gram-negative bacteria are an important cause of severe sepsis. Recent studies have demonstrated reduced susceptibillty of Gram-negative bacteria to currently available antimicrobial agents. METHODS: We performed a retrospective cohort study of patients with severe sepsis who were bacteremic with Pseudomonas aeruginosa, Acinetobacter species, or Enterobacteriaceae from 2002 to 2007. Patients were identified by the hospital informatics database and pertinent clinical data (demographics, baseline severity of illness, source of bacteremia, and therapy) were retrieved from electronic medical records. All patients were treated with antimicrobial agents within 12 hours of having blood cultures drawn that were subsequently positive for bacterial pathogens. The primary outcome was hospital mortality. RESULTS: A total of 535 patients with severe sepsis and Gram-negative bacteremia were identified. Hospital mortality was 43.6%, and 82 (15.3%) patients were treated with an antimicrobial regimen to which the causative pathogen was resistant. Patients infected with a resistant pathogen had significantly greater risk of hospital mortality (63.4% vs 40.0%; P < 0.001). In a multivariate analysis, infection with a pathogen that was resistant to the empiric antibiotic regimen, increasing APACHE II scores, infection with Pseudomonas aeruginosa, healthcare-associated hospital-onset infection, mechanical ventilation, and use of vasopressors were independently associated with hospital mortality. CONCLUSIONS: In severe sepsis attributed to Gram-negative bacteremia, initial treatment with an antibiotic regimen to which the causative pathogen is resistant was associated with increased hospital mortality. This finding suggests that rapid determination of bacterial susceptibility could influence treatment choices in patients with severe sepsis potentially improving their clinical outcomes. Journal of Hospital Medicine 2011;6:405-410. (C) 2011 Society of Hospital Medicine
引用
收藏
页码:405 / 410
页数:6
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