title: Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality.
abstract: OBJECTIVE
  We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections.
  
  
  METHODS
  We used a prospective observational cohort 10-yr database. We built a subdistribution hazards model with corrections for competing risks and adjustment for potential confounders including early appropriate antimicrobial therapy.
  
  
  METHODS
  Twelve intensive care units.
  
  
  METHODS
  We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None.
  
  
  RESULTS
  We included 1562 community-acquired, 1432 hospital-acquired, and 1012 intensive care unit-acquired episodes of severe sepsis. After adjustment, we found no independent associations of the causative organism, multidrug resistance of the causative organism, infection site, or presence of bacteremia with mortality. Early appropriate antimicrobial therapy was consistently associated with better survival in the community-acquired (0.64 [0.51-0.8], p = .0001), hospital-acquired (0.72 [0.58-0.88], p = .0011), and intensive care unit-acquired (0.79 [0.64-0.97], p = .0272) groups.
  
  
  CONCLUSIONS
  The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.
authors.affiliation: Infection Control Unit, Necker University Hospital Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Timsit
authors.forename: Maïté
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Adrien
authors.initials: A
authors.lastname: Français
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesim
authors.forename: Adrien
authors.initials: A
authors.lastname: Descorps-Declere
authors.forename: Yohann
authors.initials: Y
authors.lastname: Dubois
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Hakim
authors.initials: H
authors.lastname: Haouache
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Toledano
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002423:Cause of Death; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D016208:Databases, Factual; D004352:Drug Resistance, Microbial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000472:pathogenicity; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000472:pathogenicity; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents