title: Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy.
abstract: BACKGROUND
  Factors capable of impacting hospital mortality in patients with septic shock remain uncertain. Our objective was to identify predictors of hospital mortality among patients who received appropriate antimicrobial therapy for bacteremic septic shock after accounting for severity of illness, resuscitation status, and processes of care.
  
  
  METHODS
  We conducted a secondary subgroup analysis of a prospective severe sepsis cohort study. Patients with septic shock and positive blood cultures who received appropriate antimicrobial therapy were included. Univariable analyses were used to identify differences between hospital survivors and non-survivors, and a multivariable logistic regression model revealed independent determinants of hospital mortality.
  
  
  RESULTS
  From January 2008 to December 2010, 58 of 224 included patients died in the hospital. Multivariable logistic regression analysis demonstrated 2 independent predictors of hospital mortality. These included continuous renal replacement therapy utilization within 48 hours of septic shock recognition (adjusted odds ratio [OR], 5.52; 95% confidence interval [CI], 1.94-16.34) and intra-abdominal infection (adjusted OR, 3.92; 95% CI, 1.47-10.79). Escherichia coli was independently associated with a lower risk of hospital mortality (adjusted OR, 0.34; 95% CI, 0.11-0.90).
  
  
  CONCLUSIONS
  Intra-abdominal infection and continuous renal replacement therapy were associated with increased hospital mortality in patients with septic shock who received appropriate antimicrobial therapy. Our findings may be explained by suboptimal intra-abdominal infection management or inadequate antimicrobial concentration in these patients.
authors.forename: David D
authors.initials: DD
authors.lastname: Leedahl
authors.forename: Heather A
authors.initials: HA
authors.lastname: Personett
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Pharmacy Services (HAP, GES), and Division of Pulmonary and Critical Care Medicine (OG and RK), Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. schramm.garrett@mayo.edu.
authors.forename: Garrett E
authors.initials: GE
authors.lastname: Schramm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*
chemical_list: D000890:Anti-Infective Agents