title: Mortality in Patients With Septic Shock by Multidrug Resistant Bacteria: Risk Factors and Impact of Sepsis Treatments.
abstract: Patients with septic shock by multidrug resistant (MDR) microorganism maybe considered a specific population of critical patients at very high risk of death in whom the effects of standard sepsis treatment has never been assessed. The objective of this retrospective analysis was to evaluate the risk factors for 30-day mortality and the impact of sepsis management in patients with septic shock caused by MDR bacteria.
  Patients with septic shock by MDR bacteria admitted to the mixed intensive care unit (ICU) of Modena University Hospital during a 6-year period were studied. The clinical and microbiological characteristics and sepsis treatments provided were analyzed and compared between survivors (S) and nonsurvivors (NS) at 30 days after septic shock appearance.
  Ninety-four patients were studied. All therapeutic interventions applied to patients during their ICU stay did not show statistical significance between S and NS groups, except for administration of immunoglobulin M (IgM) preparation which were provided more frequently in S group ( P < .05). At the multivariate adjusted analysis, preexisting cancer (odds ratio [OR] = 2.965) and Acinetobacter baumannii infections (OR = 3.197) were independently correlated with an increased risk of 30-day mortality, whereas treatment with IgM preparation was protective (OR = 0.283).
  This retrospective study showed that in patients with septic shock caused by MDR bacteria, history of cancer and infection sustained by A baumannii increase the risk of mortality and that standard sepsis treatments do not seem to provide any protective effect. Adjunctive therapy with IgM preparation seems to be beneficial, but further appropriate studies are needed to confirm the results observed.
authors.affiliation: 1 Cattedra e Struttura di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Busani
authors.affiliation: 1 Cattedra e Struttura di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Serafini
authors.affiliation: 1 Cattedra e Struttura di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Mantovani
authors.affiliation: 2 Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Venturelli
authors.affiliation: 3 Clinica di Malattie Infettive, Dipartimento di scienze mediche e chirurgiche, Università di Bologna, Bologna, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.affiliation: 3 Clinica di Malattie Infettive, Dipartimento di scienze mediche e chirurgiche, Università di Bologna, Bologna, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.affiliation: 4 Dipartimento Attività Integrata di Medicine, Medicina d'Urgenza e Specialità Mediche, Malattie infettive, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.affiliation: 5 Dipartimento di Chirurgia, Medicina, Odontoiatria e Scienze Morfologiche, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cossarizza
authors.affiliation: 1 Cattedra e Struttura di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Girardis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D064266:Preexisting Condition Coverage; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: host immune response; multidrug resistant bacteria; sepsis bundle treatment; septic shock