Antibiotic prescription patterns in the empiric therapy of severe sepsis: combination of antimicrobials with different mechanisms of action reduces mortalityReportar como inadecuado

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Critical Care

, 16:R223

First Online: 18 November 2012Received: 30 July 2012Revised: 09 October 2012Accepted: 18 October 2012


IntroductionAlthough early institution of adequate antimicrobial therapy is lifesaving in sepsis patients, optimal antimicrobial strategy has not been established.
Moreover, the benefit of combination therapy over monotherapy remains to be determined.
Our aims are to describe patterns of empiric antimicrobial therapy in severe sepsis, assessing the impact of combination therapy, including antimicrobials with different mechanisms of action, on mortality.

MethodsThis is a Spanish national multicenter study, analyzing all patients admitted to ICUs who received antibiotics within the first 6 hours of diagnosis of severe sepsis or septic shock.
Antibiotic-prescription patterns in community-acquired infections and nosocomial infections were analyzed separately and compared.
We compared the impact on mortality of empiric antibiotic treatment, including antibiotics with different mechanisms of action, termed different-class combination therapy DCCT, with that of monotherapy and any other combination therapy possibilities non-DCCT.

ResultsWe included 1,372 patients, 1,022 74.5% of whom had community-acquired sepsis and 350 25.5% of whom had nosocomial sepsis.
The most frequently prescribed antibiotic agents were β-lactams 902, 65.7% and carbapenems 345, 25.1%.
DCCT was administered to 388 patients 28.3%, whereas non-DCCT was administered to 984 71.7%.
The mortality rate was significantly lower in patients administered DCCTs than in those who were administered non-DCCTs 34% versus 40%; P = 0.042.
The variables independently associated with mortality were age, male sex, APACHE II score, and community origin of the infection.
DCCT was a protective factor against in-hospital mortality odds ratio OR, 0.699; 95% confidence interval CI, 0.522 to 0.936; P = 0.016, as was urologic focus of infection OR, 0.241; 95% CI, 0.102 to 0.569; P = 0.001.

Conclusionsβ-Lactams, including carbapenems, are the most frequently prescribed antibiotics in empiric therapy in patients with severe sepsis and septic shock.
Administering a combination of antimicrobials with different mechanisms of action is associated with decreased mortality.

AbbreviationsAPACHE IIAcute Physiology and Chronic Health Evaluation II

DCCTdifferent-class combination therapy

ICUintensive care unit.

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Autor: Ana Díaz-Martín - María Luisa Martínez-González - Ricard Ferrer - Carlos Ortiz-Leyba - Enrique Piacentini - Maria Jesu



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