[Septic shock in patients with blood diseases. Analysis of clinical situation, treatment and outcome in sixty patients].
Septic shock is one of the major direct causes of death in patients in hematology departments. The aim of the study was to identify situations and factors associated with septic shock in patients with blood diseases. We analyzed the medical treatment of septic shock and its outcome, we based on data from clinical history.


METHODS
The analyzed group consisted of 60 patients with septic shock, 32 women and 28 men, aged between 20 and 79 years with different blood diseases, hospitalized between 1998 and 2004.


RESULTS
Value of APACHE III scale (acute physiology and chronic health evaluation III scale) at the beginning of septic shock was statistically significantly higher for the non-survivors of septic shock than for the survivors (p < 0.001). Septic shock in the analyzed group was associated in similar proportion with presence of Gram-positive (the most often cultured: Staphylococcus epidermidis) and Gram-negative bacteria (the most often cultured: Escherichia coli). The mortality due to septic shock caused by Gram-positive and Gram-negative microorganisms was also similar. We have found no differences in the mortality between neutropenic and non-neutropenic patients. If empirical treatment instituted at the beginning of shock was concordant with result of in vitro sensitivity testing received later, 81% of patients survived septic shock. The survival rate of patients with septic shock receiving discordant antimicrobial treatment was equal 11% and it was statistically less in comparison with patients, when the treatment was concordant (81% vs 11% p < 0.05). When the blood cultures were negative, the adequacy of antibiotic therapy was impossible to confirm and in this group 53% survival rate was noted (81% vs 53%, p < 0.05). In 37 cases, septic shock appeared in patients treated with antibiotics before the onset of septic shock. In this group of patients the highest percent of deaths was noted, when the antibiotic therapy after the moment of starting of septic shock was not changed and was higher in comparison to group, where the treatment was totally changed (64% vs 43% respectively, p < 0.05).


CONCLUSIONS
The most important factors influencing survival in septic shock is patient's organ sufficiency and adequacy of applied antibiotics (early goal-directed antibiotic therapy)--in the same way the sensitivity of microorganisms to this treatment. The neutropenia didn't influence an outcome. The best results were achieved in patients whom combinations of three antibiotics were given: beta-lactam + aminoglicoside + glicopeptide antibiotic or carbapenem + glicopeptide antibiotic + fluorochinolon.
Waszczuk-Gajda
Anna
A
Klinika Hematologii, Onkologii i Chorób Wewnetrznych, Akademii Medycznej w Warszawie. annawaszczuk@interia.pl
Krzyścin
Mariola
M
Kamiński
Michał
M
Snarski
Emilian
E
Wiktor-Jedrzejczak
Wiesław
W
D018806:APACHE; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents