Diaz-Martin A, Martinez-Gonzalez ML, Ferrer R, Ortiz-Leyba C, Piacentini E, Lopez-Pueyo MJ, Martin-Loeches I, Levy MM, Artigas A, Garnacho-Montero J, Study Group E.; Crit Care. 2012 Nov 18;16(6):R223. [Epub ahead of print]
Introduction: Although early institution of adequate antimicrobial therapy is life-saving in septic 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 empirical antimicrobial therapy in severe sepsis, assessing the impact of combination therapy including antimicrobials with different mechanisms of action on mortality.
Methods: Spanish national multicenter study, analyzing all patients admitted to ICUs who received antibiotics within the first six 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).
Results: We included 1372 patients, 1022 of whom (74.5%) had community-acquired sepsis and 350 (25.5%) of whom had nosocomial sepsis. The most frequently prescribed antibiotic agents were SZ-lactams (902, 65.7%) and carbapenems (345, 25.1%). DCCT was administered to 388 patients (28.3%) whereas non-DCCT therapy was administered to 984 (71.7%). The mortality rate was significantly lower in patients administered DCCT than in those administered non-DCCT (34% vs 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 (OR 0.699; 95% CI 0.522-0.936; p=0.016), as was urological focus of infection (OR 0.241; 95% CI 0.102-0.569; p=0.001).
Conclusions: SZ-lactams, including carbapenems, are the most frequently prescribed antibiotics in empirical therapy in patients with severe sepsis and septic shock. Administering a combination of antimicrobials with different mechanisms of action is associated with decreased mortality.
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