title: Empirical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome.
abstract: OBJECTIVE
  To assess the adequacy of empirical antimicrobial therapy prescribed in septic shock patients and to evaluate the relationship between inadequate antimicrobial therapy and 30-day mortality.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Medical-surgical (16-bed) intensive care unit in an urban teaching hospital.
  
  
  METHODS
  A total of 107 patients requiring intensive care admission were prospectively evaluated during the 3-yr period of the study.
  
  
  METHODS
  Prospective patient surveillance and data collection and assessment of antimicrobial therapy according to microbiological documentation.
  
  
  RESULTS
  A source of infection associated with a microbiological documentation was identified in 78 of the 107 patients (72%). Empirical antimicrobial therapy consisted of a pivotal antibiotic (beta-lactam) associated with an aminoglycoside (59 patients) or a fluoroquinolone (21 patients). Vancomycin was added in 14 patients. Sixty-nine of the 78 patients (89%) received an adequate antimicrobial therapy. The mortality rate of patients receiving an adequate antimicrobial therapy was 56%, and seven of the nine patients (78%) receiving an inadequate antimicrobial therapy died (p =.2). Among the 81 patients who were alive on day 3, antimicrobial therapy was modified in agreement to clinical status and microbiological documentation in 80% of cases, with de-escalation in 64% of cases. De-escalation consisted of withdrawing the nonpivotal antibiotic in 42% of patients or switching to a narrow-spectrum beta-lactam antibiotic (22% of cases).
  
  
  CONCLUSIONS
  The prescription of empirical antimicrobial therapy by a senior physician in agreement with practice guidelines made it possible to achieve a crude rate of 89% of adequate antimicrobial therapy in study patients. Inadequate antimicrobial therapy was associated with a 39% excess of mortality. A de-escalation of the empirical therapy was possible in 64% of patients.
authors.affiliation: Intensive Care Unit, Trauma Center, Marseilles University Hospital System, Marseilles School of Medicine, France. marc.leone@ap-hm.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bourgoin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cambon
authors.forename: Myriam
authors.initials: M
authors.lastname: Dubuc
authors.forename: Jacques
authors.initials: J
authors.lastname: Albanèse
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents