title: Short- and long-term mortality in severe sepsis/septic shock in a setting with low antibiotic resistance: a prospective observational study in a Swedish university hospital.
abstract: BACKGROUND
  There is little epidemiologic data on sepsis, particularly in areas of low antibiotic resistance. Here we report a prospective observational study of severe sepsis and septic shock in patients admitted to the Intensive Care Unit (ICU) at Karolinska University Hospital, Sweden. We aimed to evaluate short- and long-term mortality, and risk factors for sepsis-related death. A second aim was to investigate patient care in relation to gender.
  
  
  METHODS
  One hundred and one patients with severe sepsis and septic shock, admitted to the ICU between 2005 and 2009, were prospectively enrolled in the study. Defined primary endpoints were day 28, hospital, and 1-year mortality. Risk factors for sepsis-related death was evaluated with a multivariate analysis in a pooled analysis with two previous sepsis cohorts. In the subset of patient admitted to the ICU through the emergency department (ED), time to clinician evaluation and time to antibiotics were assessed in relation to gender.
  
  
  RESULTS
  In the septic cohort, the day 28, hospital, and 1-year mortality rates were 19, 29, and 34%, respectively. Ninety-three percent of the patients received adequate antibiotics from the beginning. Multi-resistant bacteria were only found in three cases. Among the 43 patients admitted to the ICU through the ED, the median time to antibiotics was 86 min (interquartile range 52-165), and overall 77% received appropriate antibiotics within 2 h. Female patients received antibiotics significantly later compared to male patients (p = 0.047).
  
  
  CONCLUSIONS
  The results demonstrate relatively low mortality rates among ICU patients with severe sepsis/septic shock, as compared to reports from outside Scandinavia. Early adequate antibiotic treatment and the low incidence of resistant isolates may partly explain these findings. Importantly, a gender difference in time to antibiotic therapy was seen.
authors.affiliation: Division of Infectious Diseases, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Linnér
authors.affiliation: Division of Infectious Diseases, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Sundén-Cullberg
authors.affiliation: Division of Infectious Diseases, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Johansson
authors.affiliation: Department of Anesthesiology, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Hjelmqvist
authors.affiliation: Division of Infectious Diseases, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Norrby-Teglund
authors.affiliation: Division of Infectious Diseases, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Treutiger
keywords: antibiotics; gender; mortality; septic shock; severe sepsis