title: The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment*.
abstract: OBJECTIVE
  To identify the determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment.
  
  
  METHODS
  A retrospective cohort study of hospitalized patients with blood culture positive septic shock (January 2002-December 2007).
  
  
  METHODS
  Barnes-Jewish Hospital, a 1,250-bed urban teaching hospital.
  
  
  METHODS
  Four hundred thirty-six consecutive patients with septic shock and a positive blood culture.
  
  
  METHODS
  Data abstraction from computerized medical records.
  
  
  RESULTS
  Septic shock was associated with bloodstream infection due to Gram-negative bacteria (59.2%) and Gram-positive bacteria (40.8%). Two hundred twenty-four patients (51.4%) died during their hospitalization. The presence of infection attributed to antibiotic-resistant bacteria was similar for patients who survived and expired (22.6% vs. 20.1%; p = .516). Multivariate logistic regression analysis demonstrated that infection acquired in the intensive care unit (adjusted odds ratio 1.99; 95% confidence interval 1.52-2.60; p = .011) and increasing Acute Physiology and Chronic Health Evaluation II scores (one-point increments) (adjusted odds ratio 1.11; 95% confidence interval 1.09-1.14; p < .001) were independently associated with a greater risk of hospital mortality, whereas infection with methicillin-susceptible Staphylococcus aureus (adjusted odds ratio 0.32; 95% confidence interval 0.20-0.52; p = .017) was independently associated with a lower risk of hospital mortality. Patients infected with methicillin-susceptible Staphylococcus aureus infections were statistically younger and had lower Charlson comorbidity and Acute Physiology and Chronic Health Evaluation II scores compared to patients with non-methicillin-susceptible Staphylococcus aureus infections.
  
  
  CONCLUSIONS
  Among patients with septic shock who receive appropriate initial antibiotic treatment, acquisition of infection in the intensive care unit and severity of illness appear to be the most important determinants of clinical outcome.
authors.affiliation: Division of Pulmonary and Critical Care, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Labelle
authors.forename: Paul
authors.initials: P
authors.lastname: Juang
authors.forename: Richard
authors.initials: R
authors.lastname: Reichley
authors.forename: Scott
authors.initials: S
authors.lastname: Micek
authors.forename: Justin
authors.initials: J
authors.lastname: Hoffmann
authors.forename: Alex
authors.initials: A
authors.lastname: Hoban
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hampton
authors.forename: Marin
authors.initials: M
authors.lastname: Kollef
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D003428:Cross Infection / Q000401:mortality; D017707:Erythrocyte Transfusion; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015999:Multivariate Analysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents