title: Impact of Sepsis Classification and Multidrug-Resistance Status on Outcome Among Patients Treated With Appropriate Therapy.
abstract: OBJECTIVE
  To assess the impact of sepsis classification and multidrug-resistance status on outcome in patients receiving appropriate initial antibiotic therapy.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Barnes-Jewish Hospital, a 1,250-bed teaching hospital.
  
  
  METHODS
  Individuals with Enterobacteriaceae sepsis, severe sepsis, and septic shock who received appropriate initial antimicrobial therapy between June 2009 and December 2013.
  
  
  METHODS
  Clinical outcomes were compared according to multidrug-resistance status, sepsis classification, demographics, severity of illness, comorbidities, and antimicrobial treatment.
  
  
  RESULTS
  We identified 510 patients with Enterobacteriaceae bacteremia and sepsis, severe sepsis, or septic shock. Sixty-seven patients (13.1%) were nonsurvivors. Mortality increased significantly with increasing severity of sepsis (3.5%, 9.9%, and 28.6%, for sepsis, severe sepsis, and septic shock, respectively; p < 0.05). Time to antimicrobial therapy was not significantly associated with outcome. Acute Physiology and Chronic Health Evaluation II was more predictive of mortality than age-adjusted Charlson comorbidity index. Multidrug-resistance status did not result in excess mortality. Length of ICU and hospital stay increased with more severe sepsis. In multivariate logistic regression analysis, African-American race, sepsis severity, Acute Physiology and Chronic Health Evaluation II score, solid-organ cancer, cirrhosis, and transfer from an outside hospital were all predictors of mortality.
  
  
  CONCLUSIONS
  Our results support sepsis severity, but not multidrug-resistance status as being an important predictor of death when all patients receive appropriate initial antibiotic therapy. Future sepsis trials should attempt to provide appropriate antimicrobial therapy and take sepsis severity into careful account when determining outcomes.
authors: 1Division of Medical Education, Washington University School of Medicine, St. Louis, MO. 2Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO. 3Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO.
authors: Jason P
authors: JP
authors: Burnham
authors: Michael A
authors: MA
authors: Lane
authors: Marin H
authors: MH
authors: Kollef
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000145:classification / Q000188:drug therapy* / Q000401:mortality*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality; D012959:Socioeconomic Factors; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents