Empirical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome.
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.
Leone
Marc
M
Intensive Care Unit, Trauma Center, Marseilles University Hospital System, Marseilles School of Medicine, France. marc.leone@ap-hm.fr
Bourgoin
Aurélie
A
Cambon
Sylvie
S
Dubuc
Myriam
M
Albanèse
Jacques
J
Martin
Claude
C
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
D000900:Anti-Bacterial Agents