title: A multicentre case-control study of nonsteroidal anti-inflammatory drugs as a risk factor for severe sepsis and septic shock.
abstract: BACKGROUND
  We aimed to establish whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during evolving bacterial community-acquired infection in adults is associated with severe sepsis or septic shock.
  
  
  METHODS
  We conducted a multicentre case-control study in eight intensive care units. Cases were all adult patients admitted for severe sepsis or septic shock due to a bacterial community-acquired infection. Control individuals were patients hospitalized with a mild community-acquired infection. Each case was matched to one control for age, presence of diabetes and site of infection.
  
  
  RESULTS
  The main outcome measures were the proportions of cases and controls exposed to NSAIDs or aspirin during the period of observation. In all, 152 matched pairs were analyzed. The use of NSAIDs or aspirin during the observation period did not differ between cases and controls (27% versus 28; odds ratio = 0.93, 95% confidence interval [CI] = 0.52 to 1.64). If aspirin was not considered or if a distinction was made between acute and chronic drug treatment, there remained no difference between groups. However, the median time to prescription of effective antibiotic therapy was longer for NSAID users (6 days, 95% CI = 3 to 7 days) than for nonusers (3 days, 95% CI = 2 to 3 days; P = 0.02).
  
  
  CONCLUSIONS
  In this study, the use of NSAIDs or aspirin during evolving bacterial infection was frequent and occurred in one-quarter of the patients with such infection. Although the use of NSAIDs by patients with severe sepsis or septic shock did not differ from their use by those with mild infection at the same infected site, we observed a longer median time to prescription of effective antibiotic therapy in NSAID users.
authors.affiliation: Department of Intensive Care Unit, University Hospital of Tours, Boulevard Tonnellé, 37044 Tours, France. a.legras@chu-tours.fr
authors.forename: Annick
authors.initials: A
authors.lastname: Legras
authors.forename: Bruno
authors.initials: B
authors.lastname: Giraudeau
authors.forename: Annie-Pierre
authors.initials: AP
authors.lastname: Jonville-Bera
authors.forename: Christophe
authors.initials: C
authors.lastname: Camus
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.forename: Isabelle
authors.initials: I
authors.lastname: Runge
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.forename: Anne
authors.initials: A
authors.lastname: Veinstein
authors.forename: Jérome
authors.initials: J
authors.lastname: Tayoro
authors.forename: Daniel
authors.initials: D
authors.lastname: Villers
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Autret-Leca